Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 13 , ISSUE 2 ( March-April, 2021 ) > List of Articles

CASE REPORT

Placenta Percreta Presenting as an Acute Obstetric Emergency in Mid-second Trimester: A Case Report

Citation Information : Placenta Percreta Presenting as an Acute Obstetric Emergency in Mid-second Trimester: A Case Report. J South Asian Feder Obs Gynae 2021; 13 (2):135-137.

DOI: 10.5005/jp-journals-10006-1881

License: CC BY-NC 4.0

Published Online: 09-07-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aim: To know the risks and management of placenta percreta in patients with previous lower segment cesarean section (LSCS) with postabortal hemorrhage. Background: Placenta percreta, a form of adherent placenta, is associated with significant postabortal hemorrhage often requiring emergency hysterectomy. Majority of these cases are seen in patients with a history of previous LSCS with anterior low-lying placenta. Case description: A 29-year-old female with previous two LSCS came at 19 weeks 4 days of gestational age with complaints of leaking per vaginum since 7 days and mild pain abdomen. Her ultrasonography showed single live intrauterine fetus (SLIUF) with anterior upper segment placenta with no evidence of accretion. She went into labor spontaneously and expelled a male baby weighing 300 gm. Subsequently, she had postabortal hemorrhage with the placenta in situ. Medical management of post-abortal hemorrhage (PAH) was given but she went into shock with massive blood loss. After stabilization of the patient with iv fluids and colloids, she was taken up for emergency laparotomy, in view of retained placenta with previous two LSCS with postabortal hemorrhage as medical management failed. On laparotomy, the placenta was anterior and was invading the wall of the uterus up to the serosa. As she was bleeding torrentially, an emergency hysterectomy was done without any delay in decision-making. She was transfused with four packed red blood cells (PRBC) and four fresh frozen plasma (FFPs). Her postoperative period was uneventful and she was discharged on day 7 in astable condition. Histopathological findings confirmed the absence of the placental basal plate and the presence of trophoblastic tissue in the myometrium and serosa. Conclusion: Good anticipation and timely decision are very important in decreasing maternal morbidity and mortality in cases of PPH with adherent placentas, like in other obstetric emergencies. Clinical significance: We wish to highlight the importance of good clinical knowledge with timely decision by OB/Gyn team in a patient with PPH and placenta percreta encountered in the mid-second trimester.


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  1. Zhang D, Siqin Y, Yanyan H, et al. Risk factors, outcome and management survey of placenta accreta disorders in 153 cases: A five-year experience from a hospital of Shanghai, China. Int J Clin Exp Med 2017;10(8):12509–12516.
  2. Oyelese Y, Smulian JC. Placenta previa, PAS disorders, and vasa previa. Obstet Gynecol 2006;107(4):927–941. DOI: 10.1097/01.AOG.0000207559.15715.98.
  3. Usta IM, Hobeika EM, Musa AA, et al. Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol 2005;193:1045–1049. DOI: 10.1016/j.ajog.2005.06.037.
  4. Eshkoli T, Weintraub AY, Sergienko R, et al. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol 2013;208(3):219.e1–219.e7. DOI: 10.1016/j.ajog.2012.12.037.
  5. Bowman ZS, Eller AG, Bardsley TR, et al. Risk factors for placenta accreta: a large prospective cohort. Am J Perinatol 2014;31(9):799–804. DOI: 10.1055/s-0033-1361833.
  6. Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol 2011;205(3):262.e1–262.e8. DOI: 10.1016/j.ajog.2011.06.035.
  7. Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Obstet Gynecol 2006;107(6):1226–1232. DOI: 10.1097/01.AOG.0000219750.79480.84.
  8. D'Antonio F, Iacovella C, Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013;42(5):509–517. DOI: 10.1002/uog.13194.
  9. Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med 1992;11(7):333–343. DOI: 10.7863/jum.1992.11.7.333.
  10. Lam G, Kuller J, McMahon M. Use of magnetic resonance imaging and ultrasound in the antenatal diagnosis of placenta accreta. J Soc Gynecol Investig 2002;9(1):37–40. DOI: 10.1016/s1071-5576(01)00146-0.
  11. Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 2015;212(2):218.e1–218.e9. DOI: 10.1016/j.ajog.2014.08.019.
  12. Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am 2015;42(2):381–402. DOI: 10.1016/j.ogc.2015.01.014.
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