Failure of conservative management of placenta previa-percreta
ABSTRACT We present a patient with a placenta previa in which we failed to manage conservatively with methotrexate and uterine embolization. The patient was diagnosed in the second trimester as having a possible placenta previa-increta,and underwent a repeat classical cesarean delivery at 32 weeks of gestation due to significant antepartum vaginal bleeding. Following abdominal closure,the uterine vessels were embolized with the Gel-Foam by interventional radiology. The placenta previa was left in-situ and patient was discharged home in stable condition in five days. The patient reported on the 44th postoperative day with heavy vaginal bleeding. A total abdominal hysterectomy was performed due to an unstable patient's hemodynamic condition in association with fluid resuscitation and multiple blood transfusions. The pathologic findings revealed a 675 g uterus with placenta previa-percreta with extension of chorionic villi to the serosal layer. Our case demonstrates a need for careful selection of patients with placenta previa and suspected accreta/increta/percreta that would be suitable candidates for conservative medical management. Patients who opt for conservative medical management should be informed about the possibility of catastrophic bleeding associated with a retained placenta, that would ultimately require blood transfusions and hysterectomy.
Article: Placenta previa accreta.[Show abstract] [Hide abstract]
ABSTRACT: The term placenta previa refers to a placenta that is abnormally located in the lower part of the uterus, often covering the cervix. The words are derived from the Latin pre, meaning before, and via, which comes from the same derivation as “viaduct” and “avenue,” meaning passageway. Thus, placenta previa means that the placenta lies before the baby in the birth canal. The placenta normally implants in the upper uterus, but in fewer than 1% of pregnancies it implants in the lower uterine segment. It was probably the French man-midwife Portal in 1683 who first described a placenta previa . Placenta previa is one of the leading causes of bleeding during the third trimester. The condition is associated with significantly increased perinatal and maternal mortality and morbidity . Perhaps the most important fetal consequence is prematurity with its associated sequelae, such as respiratory distress syndrome, high perinatal mortality, and long-term neurodevelopmental handicap. Placenta previa is also associated with significant maternal hemorrhage, a need for surgical delivery, placenta accreta, and cesarean hysterectomy .Minnesota medicine 06/1970; 53(5):537-9. DOI:10.1007/978-1-4419-9810-1_8
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ABSTRACT: Retained placenta is a serious cause of postpartum hemorrhage. Compounding this problem is the rare finding of a retained placenta accreta. Different authors have presented management options for retained placenta accreta that include methotrexate, uterine artery embolization, dilation and curettage, hysteroscopic loop resection, and hysterectomy. We report here on a patient who was diagnosed with a retained placenta accreta and underwent successful conservative treatment with uterine artery embolization followed by hysteroscopic morcellation. Whereas other methods have failed due to bleeding and/or infection, this case illustrates a potential new means of addressing this challenging obstetrical complication.Journal of Minimally Invasive Gynecology 07/2006; 13(4):342-4. DOI:10.1016/j.jmig.2006.04.008 · 1.58 Impact Factor