Molly Dickinson, DO, on the rare repair of a 22-week uterine rupture with placenta accreta

Uterine rupture during the second trimester is an exceptionally rare obstetrical complication that typically necessitates the immediate evacuation of the uterus. However, at the 2026 American College of Obstetricians & Gynecologists (ACOG) Annual Clinical & Scientific Meeting, Molly Dickinson, DO, Jefferson Einstein Philadelphia Hospital, presented a unique case report involving the successful repair of a 22-week rupture, allowing for the delivery of a healthy infant at 32 weeks. The case was further complicated by the presence of placenta accreta, identified via MRI at 24 weeks and confirmed upon delivery.

22-week uterine repture repair was “game-time decision”

The patient, a 40-year-old with a history of one prior cesarean section, presented with acute abdominal pain and maternal tachycardia. While diagnostic imaging confirmed hemoperitoneum, the exact cause remained uncertain until the surgical team began the procedure.

"We discovered the uterine rupture, and had to make a game time decision, do we repair it? Do we evacuate the uterus? Do we need to do a hysterectomy?" Dickinson recalled. The surgical team identified a 2-cm rupture in the right lower uterine segment with protruding placental tissue. Dickinson noted that because the bleeding source was identifiable and there was "enough tissue to repair it," the team opted for a purse-string suture repair.

This decision was heavily influenced by the clinical context: the rupture was caused by trauma rather than preterm labor. "I think that had she come in with contractions and preterm labor, we would not have made the same decision," Dickinson explained.

The role of shared decision-making

"Given this was a highly desired pregnancy for this patient, all of those decisions played into being able to repair the uterus, and ultimately her being able to go on to successfully deliver at 32 weeks," Dickinson said. She emphasized that "shared decision making with the patient" before surgery was vital, even though the team did not know exactly what they would find.

Outcome and clinical implications

Following the repair, the pregnancy continued for an additional 10 weeks. At 32 weeks, the patient underwent a planned cesarean hysterectomy, delivering a 1775-g neonate with Apgar scores of 7 and 9. The supracervical hysterectomy was completed without complication, and pathology confirmed the suspected placenta accreta.

Dickinson concluded that success in such rare scenarios requires a "high suspicion" of rupture even at early gestational ages and rapid movement to the operating room. The unique combination of a 22-week repair and the presence of placenta accreta resulting in a healthy infant at 32 weeks marks a significant addition to the limited reports of pregnancy continuation after uterine rupture.

Reference:

Dickinson M, Jaeger AJ, Goldberg M. Repair of uterine rupture with placenta accreta at 22 weeks followed by cesarean hysterectomy delivery of healthy infant at 32 weeks. Poster. Presented at: American College of Obstetricians & Gynecologists Annual Clinical & Scientific Meeting. May 1-3, 2026. Washington, D.C.