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Placenta percreta resulting in incomplete spontaneous abortion in first trimester.

Genc M, Genc B, Solak A, Sivrikoz ON - Int J Fertil Steril (2014)

Bottom Line: She had persistent vaginal bleeding for 2 months after the curettage, for which she was treated with hysterectomy.Preoperative ultrasonography and magnetic resonance imaging (MRI) made the diagnosis of placenta percreta.Postoperative pathological examination confirmed this diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Sifa University School of Medicine, Izmir, Turkey.

ABSTRACT
Placenta percreta is a rare complication potentially fatal to fetus and the mother. We present here a 41-year-old female patient who underwent curettage for incomplete abortion at 6(th) week of pregnancy. She had persistent vaginal bleeding for 2 months after the curettage, for which she was treated with hysterectomy. Preoperative ultrasonography and magnetic resonance imaging (MRI) made the diagnosis of placenta percreta. Postoperative pathological examination confirmed this diagnosis.

No MeSH data available.


Related in: MedlinePlus

Macrophotography demonstrates hemorrhagic placental residue containing necrotic villi interspersed in muscle tissue.
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Figure 4: Macrophotography demonstrates hemorrhagic placental residue containing necrotic villi interspersed in muscle tissue.

Mentions: 41-year-old female G3 P2 L1 A1 with historyof 2 previous cesarean deliveries, presented toour clinic with protracted vaginal bleeding. Itwas learnt that she had undergone curettagefor incomplete abortion at an outside center 2months ago, following which she had persistentvaginal bleeding. She did not apply to anyhealthcare facility because her socioculturallevel was low and she resided in a rural area ofİzmir, Turkey. She could not have any sexual intercourseas a result of protracted bleeding. Herhemoglobin was 7.1 g/dl, and beta-human chorionicgonadotropin (β-HCG) was 130 mIU/ml.Transabdominal and transvaginal ultrasonography(USG) was used to rule out abortion imminensand extrauterine pregnancy. Transvaginalcolor Doppler ultrasonography revealed a20 mm solid mass lesion with smooth contourcompressing endometrium anterior to uterine isthmusas well as a dense fluid collection within the cavity (Fig 1). T2-wieghted (T2W) magnetic resonance imaging (MRI) showed hyperintense lesions extending to endometrial cavity at the anterior part of isthmus (Fig 2A). Fat suppression axial T2W images demonstrated fluid collection in the cavity and a hyperintense lesion in the myometrium (Fig 2B). Pre and post contrast T1W sagittal images showed a myometrial mass lesion with localized contrast uptake and a hematoma compressing the cavity (Fig 2C). Considering the elevated β-HCG level, it was suggested that the mass lesion in myometrium may be secondary to residual placenta. A discussion was made with the patient and hysterectomy was planned. Explorative operation showed that urinary bladder was adhered to anterior uterine wall at the lower uterine segment and there was a formation consistent with placenta percreta extending beyond the serosa and invading the urinary bladder at the site of previous caesarean section. Placenta was detached from urinary bladder and hysterectomy was performed. Urinary bladder was repaired. The hysterectomy material was sent for pathological examination, which revealed a lesion consistent with placenta localized to myometrium and extending to serosa at the level of isthmus, and a hematoma opening to endometrial cavity medial to this lesion (Fig 3). Histopathological examination revealed that chorionic villi invaded myometrium and extended to serosa (Fig 4), thus confirming the diagnosis of placenta percreta.


Placenta percreta resulting in incomplete spontaneous abortion in first trimester.

Genc M, Genc B, Solak A, Sivrikoz ON - Int J Fertil Steril (2014)

Macrophotography demonstrates hemorrhagic placental residue containing necrotic villi interspersed in muscle tissue.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4221523&req=5

Figure 4: Macrophotography demonstrates hemorrhagic placental residue containing necrotic villi interspersed in muscle tissue.
Mentions: 41-year-old female G3 P2 L1 A1 with historyof 2 previous cesarean deliveries, presented toour clinic with protracted vaginal bleeding. Itwas learnt that she had undergone curettagefor incomplete abortion at an outside center 2months ago, following which she had persistentvaginal bleeding. She did not apply to anyhealthcare facility because her socioculturallevel was low and she resided in a rural area ofİzmir, Turkey. She could not have any sexual intercourseas a result of protracted bleeding. Herhemoglobin was 7.1 g/dl, and beta-human chorionicgonadotropin (β-HCG) was 130 mIU/ml.Transabdominal and transvaginal ultrasonography(USG) was used to rule out abortion imminensand extrauterine pregnancy. Transvaginalcolor Doppler ultrasonography revealed a20 mm solid mass lesion with smooth contourcompressing endometrium anterior to uterine isthmusas well as a dense fluid collection within the cavity (Fig 1). T2-wieghted (T2W) magnetic resonance imaging (MRI) showed hyperintense lesions extending to endometrial cavity at the anterior part of isthmus (Fig 2A). Fat suppression axial T2W images demonstrated fluid collection in the cavity and a hyperintense lesion in the myometrium (Fig 2B). Pre and post contrast T1W sagittal images showed a myometrial mass lesion with localized contrast uptake and a hematoma compressing the cavity (Fig 2C). Considering the elevated β-HCG level, it was suggested that the mass lesion in myometrium may be secondary to residual placenta. A discussion was made with the patient and hysterectomy was planned. Explorative operation showed that urinary bladder was adhered to anterior uterine wall at the lower uterine segment and there was a formation consistent with placenta percreta extending beyond the serosa and invading the urinary bladder at the site of previous caesarean section. Placenta was detached from urinary bladder and hysterectomy was performed. Urinary bladder was repaired. The hysterectomy material was sent for pathological examination, which revealed a lesion consistent with placenta localized to myometrium and extending to serosa at the level of isthmus, and a hematoma opening to endometrial cavity medial to this lesion (Fig 3). Histopathological examination revealed that chorionic villi invaded myometrium and extended to serosa (Fig 4), thus confirming the diagnosis of placenta percreta.

Bottom Line: She had persistent vaginal bleeding for 2 months after the curettage, for which she was treated with hysterectomy.Preoperative ultrasonography and magnetic resonance imaging (MRI) made the diagnosis of placenta percreta.Postoperative pathological examination confirmed this diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Sifa University School of Medicine, Izmir, Turkey.

ABSTRACT
Placenta percreta is a rare complication potentially fatal to fetus and the mother. We present here a 41-year-old female patient who underwent curettage for incomplete abortion at 6(th) week of pregnancy. She had persistent vaginal bleeding for 2 months after the curettage, for which she was treated with hysterectomy. Preoperative ultrasonography and magnetic resonance imaging (MRI) made the diagnosis of placenta percreta. Postoperative pathological examination confirmed this diagnosis.

No MeSH data available.


Related in: MedlinePlus