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Placenta increta as an important cause of uterine mass after first-trimester Curettage (case report).

Rouholamin S, Behnamfar F, Zafarbakhsh A - Adv Biomed Res (2014)

Bottom Line: Case II: A 32-year-old patient in the 12th week of gestation with missed abortion.Total abdominal hysterectomy was performed.In patients with a history of recent first-trimester abortion presenting with prolonged vaginal bleeding, uterine mass and low-level BHCG, a diagnosis of abnormal placentaion should be kept in mind.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

ABSTRACT
Placenta increta during the first trimester of pregnancy is very rare. This report describes two cases of placenta increta that caused prolonged vaginal bleeding after a first-trimester abortion. We were encountered two cases of placenta increta in October 2012 and May 2013. Case I: A 35-year-old patient with continues vaginal bleeding from 2 months after curettage due to missed abortion in the first trimester. The uterus was large, the human chorionic gonadotropin (BHCG) level was 112 mUI/mL and ultrasound showed an echogenic mass in the lower segment of the uterine cavity. She was a candidate for curettage but received hysterectomy because of massive vaginal bleeding. Pathology reported placenta increta. Case II: A 32-year-old patient in the 12th week of gestation with missed abortion. After 6 weeks from curettage, she returned with continues vaginal bleeding, BHCG = 55 mUI/mL and sonography showing mixed echo lesion in the uterine cavity like hydatiform mole. Total abdominal hysterectomy was performed. Pathology reported placenta increta. In patients with a history of recent first-trimester abortion presenting with prolonged vaginal bleeding, uterine mass and low-level BHCG, a diagnosis of abnormal placentaion should be kept in mind.

No MeSH data available.


Related in: MedlinePlus

Uterus with lower segment mass
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Figure 2: Uterus with lower segment mass

Mentions: Physical examination was normal. The gynecologic examination of the vulva and vagina was normal, the cervix was closed, the uterus was larger than normal at about 10-12 weeks of gestation, retrovert axis and she had mild bleeding. In the clinical test, her Hb was 12.4, U/A was NL (without hematuria), BHCG was 112 mUI/mL and other coagulation tests, hepatic and renal tests and electrolytes were normal. Transvaginal sonography was performed as requested: UT > NI, retrovert uterus, endometrial thickness = 2.6 mm, hypoechotic mass about 8 cm in the lower uterine segment with necrotic change and increased vascularity with low resistance was seen around it [Figure 1]. Differential diagnosis included invasive mole, chorio carcinoma and uterine tumors, including degenerating myoma. Total abdominal sonography and chest X ray were normal. Surgical intervention was suggested and arranged to confirm the diagnosis and to remove the lower uterine segment mass. Surgery was performed with the patient under general anesthesia and in the 15-degree Trendelenburg position. A Foley catheter was inserted preoperatively to empty the bladder. She received suction and curettage. After removing the debris and much necrotic tissue, vaginal hemorrhage could not be controlled during operation. The decision fell on laparatomy. The lower segment uterine mass appeared as a large, friable, highly vascularized mass that occupied the whole thickness of the uterine. Hysterectomy was performed immediately for treatment of hemorrhage-induced hypotension, fluid replacement and packed blood cells and blood products were administered [Figure 2]. For more than care, she was transferred to the Intensive Care Unit. On the day after surgery, the BHCG level decreased to about 13 mUI/mL. The patient was discharged on the third postoperative day after an uneventful recovery. Definitive pathology of the surgical specimen led to a diagnosis of necrotic and hemorrhagic placental tissue, consistent with placenta previa and placenta increta [Figure 3].


Placenta increta as an important cause of uterine mass after first-trimester Curettage (case report).

Rouholamin S, Behnamfar F, Zafarbakhsh A - Adv Biomed Res (2014)

Uterus with lower segment mass
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260288&req=5

Figure 2: Uterus with lower segment mass
Mentions: Physical examination was normal. The gynecologic examination of the vulva and vagina was normal, the cervix was closed, the uterus was larger than normal at about 10-12 weeks of gestation, retrovert axis and she had mild bleeding. In the clinical test, her Hb was 12.4, U/A was NL (without hematuria), BHCG was 112 mUI/mL and other coagulation tests, hepatic and renal tests and electrolytes were normal. Transvaginal sonography was performed as requested: UT > NI, retrovert uterus, endometrial thickness = 2.6 mm, hypoechotic mass about 8 cm in the lower uterine segment with necrotic change and increased vascularity with low resistance was seen around it [Figure 1]. Differential diagnosis included invasive mole, chorio carcinoma and uterine tumors, including degenerating myoma. Total abdominal sonography and chest X ray were normal. Surgical intervention was suggested and arranged to confirm the diagnosis and to remove the lower uterine segment mass. Surgery was performed with the patient under general anesthesia and in the 15-degree Trendelenburg position. A Foley catheter was inserted preoperatively to empty the bladder. She received suction and curettage. After removing the debris and much necrotic tissue, vaginal hemorrhage could not be controlled during operation. The decision fell on laparatomy. The lower segment uterine mass appeared as a large, friable, highly vascularized mass that occupied the whole thickness of the uterine. Hysterectomy was performed immediately for treatment of hemorrhage-induced hypotension, fluid replacement and packed blood cells and blood products were administered [Figure 2]. For more than care, she was transferred to the Intensive Care Unit. On the day after surgery, the BHCG level decreased to about 13 mUI/mL. The patient was discharged on the third postoperative day after an uneventful recovery. Definitive pathology of the surgical specimen led to a diagnosis of necrotic and hemorrhagic placental tissue, consistent with placenta previa and placenta increta [Figure 3].

Bottom Line: Case II: A 32-year-old patient in the 12th week of gestation with missed abortion.Total abdominal hysterectomy was performed.In patients with a history of recent first-trimester abortion presenting with prolonged vaginal bleeding, uterine mass and low-level BHCG, a diagnosis of abnormal placentaion should be kept in mind.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

ABSTRACT
Placenta increta during the first trimester of pregnancy is very rare. This report describes two cases of placenta increta that caused prolonged vaginal bleeding after a first-trimester abortion. We were encountered two cases of placenta increta in October 2012 and May 2013. Case I: A 35-year-old patient with continues vaginal bleeding from 2 months after curettage due to missed abortion in the first trimester. The uterus was large, the human chorionic gonadotropin (BHCG) level was 112 mUI/mL and ultrasound showed an echogenic mass in the lower segment of the uterine cavity. She was a candidate for curettage but received hysterectomy because of massive vaginal bleeding. Pathology reported placenta increta. Case II: A 32-year-old patient in the 12th week of gestation with missed abortion. After 6 weeks from curettage, she returned with continues vaginal bleeding, BHCG = 55 mUI/mL and sonography showing mixed echo lesion in the uterine cavity like hydatiform mole. Total abdominal hysterectomy was performed. Pathology reported placenta increta. In patients with a history of recent first-trimester abortion presenting with prolonged vaginal bleeding, uterine mass and low-level BHCG, a diagnosis of abnormal placentaion should be kept in mind.

No MeSH data available.


Related in: MedlinePlus