Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 10 , ISSUE 4S1 ( October-December, 2018 ) > List of Articles

CASE REPORT

A Rare Case of Morbidly Adherent Placenta in a Primigravida

Hemlata Kuhite, Sharayu Mirji, Sangeeta Shingatgeri, Ganesh Shinde

Keywords : Adherent placenta, Conservative management, Primigravida, Uterine artery embolization

Citation Information : Kuhite H, Mirji S, Shingatgeri S, Shinde G. A Rare Case of Morbidly Adherent Placenta in a Primigravida. J South Asian Feder Obs Gynae 2018; 10 (4S1):351-354.

DOI: 10.5005/jp-journals-10006-1622

License: CC BY-NC 4.0

Published Online: 01-01-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Aim: To report the occurrence of adherent placenta in the absence of prior risk factors and discuss the various management options especially conservative management. Background: Morbidly adherent placenta (MAP) refers to any placental implantation with abnormally firm adherence to myometrium. Morbid adherence of placenta has evolved into one of the most serious problems in obstetrics. The incidence has increased tenfold in the past 50 years due to the increasing number of cesarean sections and has reached seemingly epidemic proportions. The American College of Obstetricians and Gynaecologists cites the incidence to be as high as 1 in 533 deliveries. Case report: We report a case of placenta increta in a primigravida successfully managed by a conservative method with injection methotrexate followed by uterine artery embolization. Conclusion: Selected cases of morbidly adherent placenta can be successfully managed conservatively. With proper selection of cases and adequate monitoring, modern conservative techniques have made preservation of fertility possible. Clinical significance: Only four cases of the adherent placenta in primigravida without any risk factors have been reported in the literature. Fertility preservation is a major concern in the management of these patients.


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  1. Wu S, Kocherginsky M, et al. Abnormal placenta: twenty-year analysis. Am J Obstet Gynecol 2005;192:1458-1461.
  2. ACOG committee opinion. Placenta accreta. Number 266, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002 Apr;77(1):77-78.
  3. Berg CJ, Callaghan WM, et al. Pregnancy-related mortality in the United States, 1998-2005. Obstet Gynecol 2010;116(6):1302.
  4. Ansar A, Rauf N, et al. Spontaneous rupture of primigravid uterus due to morbidly adherent placenta. Journal of the College of Physicians and Surgeons Pakistan 2009;19(11): 732-733
  5. Arnadottir BT, Hardardóttir H, et al. Case report seventeen year old primipara with placenta increta treated with methotrexate. Laeknabladid 2008;94(7-8):549-52.
  6. Kinoshita T, Ogawa K, et al. Spontaneous rupture of the uterus due to placenta percreta at 25-weeks of gestation: a case report. J Obstetr Gynaecol Res 1996;22(2):125-128.
  7. Rajkumar B, Kumar N, et al. Placenta percreta in primigravida, an unsuspected situation. Int J Reprod Contracept Obstet Gynecol 2014;3(1):239-241
  8. Berkley EM, Abuhamad AZ. Prenatal diagnosis of placenta accreta. J Ultrasound Med 2013;32:1345–1350.
  9. Placenta praevia, placenta praevia accreta and vasa praevia: Diagnosis and Management. RCOG Green–top Guideline No. 27 January 2011.
  10. Fox H. Placenta accreta 1945-1969. Obstet Gynecol Surv 1972; 27:475-479.
  11. Arulkumaran S, Ng CS, et al. Medical treatment of placenta accreta with methotrexate. Acta Obstet Gynecol Scand 1986; 65:285-286.
  12. Kayem G, Davy C, et al. Conservative versus extirpative management in cases of placenta accreta. Obstet Gynecol 2004;104: 531-536.
  13. Timor-Tritsch. Early placenta accreta and cesarean section scar pregnancy: a review. Am J Obstet Gynecol 2012.
  14. Tong SY, Tay KH, et al. Conservative management of placenta accreta: Review of three cases. Singapore Med J 2008;49:e156-159.
  15. Timmermans S, van Hof AC, et al. Conservative management of abnormally invasive placentation. Obstet Gynecol survey 2007:62:529-539.
  16. Perez-Delboy A, Wright JD. Surgical management of placenta accrete: to leave or remove the placenta? BJOG 2014;121:163-170.
  17. Alanis M, Hurst BS, et al. Conservative management of placenta increta with selective arterial embolization preserves fertility and results in a favourable outcome in subsequent pregnancies. Fertil Steril 2006;86(5):1514.
  18. Chrisman HB, Saker MB, et al. The impact of uterine Wbroid embolization on resumption of menses and ovarian function. J Vasc Interv Radiol 2000;11(6):699-703.
  19. Chauleur C, Fanget C, et al. Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases. Hum Reprod 2008;23:1553- 1559.
  20. Descargues G, Tinlot FM, et al. Menses, fertility and pregnancy after arterial embolization for the control of postpartum haemorrhage. Hum Reprod 2004;19(2):339-343.
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