Ruptured uterus due to placenta percreta.

I NVASION of the uterine surface by the chorionic villi is Iimited by protective eIements in the decidua basalis. Wislockr has shown the presence of a mucopoIysaccharide in the decidua that serves to limit trophobIastic erosion of maternal tissue. Microscopic sections from most cases of placenta accreta show an absence of the decidua basaIis and atrophy of the decidua Vera. The degree of invasion of the chorionic viIIi whether superIicia1, deep or entireIy through the myometrium has given rise to the terms accreta, increta and percreta. Irving and Hertig2 in 1937 recorded the most compIete survey of pIacenta accreta (eightysix cases incIuding eighteen personaI cases). The authors’ findings showed that in over three-fourths of the cases the decidua, which serves as a Iine of cIeavage for the separation of the pIacenta, was compressed and contained few or no gIands. In aImost a11 cases the chorionic viIIi couId be seen invading the myometrium. The first recorded case of rupture of the uterus due to pIacenta percreta was that by AIexandroff3 in Igoo. In his case a hysterectomy was performed and the patient Iived. A review of the Iiterature by Hertig and Irving up to r 937 covering eighty-six cases of pIacenta accreta showed only four instances of spontaneous rupture due to chorionic viIIi penetrating the visceral peritonea1 surface of the uterus. The case reported herein iIIustrates such a condition,