Paradoxical Uterine Rupture and Fetal Survival in Placenta Accreta: A Case Report.

We describe a case of uterine rupture in the presence of abnormally invasive placentation, with fetal survival despite a long rupture-to-delivery interval (19.5 hours). The patient had previously had an intrapartum stillbirth delivered via caesarean section with an atypical uterine incision at 34 weeks' gestation. She presented to a nearby hospital with abdominal pain at 25 weeks' gestation, where an anterior uterine wall defect was diagnosed on ultrasound. A repeat ultrasound at our tertiary centre confirmed the uterine defect. With the patient reporting abdominal pain refractory to parenteral analgesia, we proceeded to delivery via laparotomy. The amniotic membrane and placental edge were visible on the abdominal entry, consistent with uterine rupture. The infant was born alive and transferred to the neonatal unit. Abnormally invasive placentation, later confirmed with histopathology, became apparent, and hysterectomy performed. We hypothesise that abnormally invasive placentation contributed to both uterine rupture and paradoxical fetal survival, as placental separation could not occur due to the placenta's abnormal invasion.