Diffuse myometrium thinning and placenta accreta spectrum in a patient with systemic lupus erythematosus (SLE): a case report and review of the literature

Abstract

Background: Cases of uterine wall thinning and placental abnormalities complicated with systemic lupus erythematosus (SLE) during pregnancy have been reported in Asian countries for ten years. Long-term steroid use can cause muscle degeneration, but the mechanism of myometrium thinning was not known. Through the review of published articles, this report is the first review of cases to discuss the pathogenesis and clinical features of thinned myometrium and placenta accreta spectrum (PAS) in pregnant patients with SLE.

Case presentation: A twenty-nine-year-old primigravida with a history of lupus enteritis and paralytic ileus had a natural conception after less than two years of steroid treatment. An ultrasonographic study showed a thin uterine wall with a widespread thick placenta on the entire surface of the uterine cavity in the third trimester. At the 39th gestational week, she underwent a cesarean section due to the failure of the uterus to contract, even though the injection of oxytocin. There were several engorged vessels on the surface of the anterior uterine wall at the time of laparotomy. We decided to perform a hysterectomy because diffuse PAS replaced her uterus.

Conclusion: A review of reported cases and our case shows an unusual complication of SLE that might be related to the particular condition of the estrogen-mediated immune system. Clinicians should always pay attention to the possibility of uterine wall thinning as uterine atony and the structural abnormality of the placenta for SLE patients with the unscarred uterus.

Keywords: Estrogen; Lupus; Myometrium; Placenta accreta spectrum; Uterine atony.

Fig. 1

Ultrasonography image. a the placenta was at anterior to bottom of the uterus without clear borderline of the placenta and the muscle layer at the 28th gestational week. b Thickened placenta with large lacunae at the bottom of the uterus at 39th gestational week

Fig. 2

Photo image. a Anterior surface of the uterus with engorged vessels at the time of laparotomy. b Atonic uterus lifted out of the pelvic cavity after bleeding control

Fig. 3

a Longitudinal image of the uterus and placenta after hysterectomy. Placenta (black arrow) attached to extreme thinned uterine wall (white arrow). b Gross photography of the uterus, which incised the anterior wall, and the placenta was attached to the widespread entire uterine wall