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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

Mixed echo lesion in the uterine cavity
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Figure 4: Mixed echo lesion in the uterine cavity

Mentions: A 32-year-old gravid 3, para 2 woman with a history of one prior cesarean section was referred to the Department of Obstetrics and Gynecology because of continuous vaginal bleeding from 3 weeks ago. The present gravidity was conceived spontaneously; it was detected in the 12th week of gestation. Physical examination and gynecologic examination of the vulva and vagina were normal. The cervix was long and rigid and mild vaginal bleeding was detected. Vaginal ultrasonography demonstrated a mass in the uterus and it was suspected to be gestational sac without fetal pole, with one of the differential diagnoses being molar pregnancy. Dilatation and curettage was down for patients and some tissue was extracted. In the curettage, she has severe vaginal bleeding that was immediately controlled with oxytocin and misoprostol. After 2 days, she was discharged from the hospital without any problems. The D&C pathology report was placenta velocity. After 1.5 months, she returned with continuance minimal and intermittent vaginal bleeding. In the physical examination, she was anemic but had stable hemodynamic, her uterine size about 14 weeks with soft and nontender uterus, cervix was closed and vaginal bleeding was less than menses period. Transvaginal sonography indicated that the uterine size was 101 mm* 50 mm * 72 mm, the endometrial thickness was about 6 mm and the mixed echo lucent lesion was 48 mm * 52 mm in myometrial thickness of the lower segment alike hydatiform mole [Figure 4] and serum BHCG was 55 mUI/mL. Based on the history and sonography findings, the differential diagnosis included either a trophoblastic tumor, especially placental site trophoblastic tumor, or a uterine myoma with degeneration. A total abdominal hysterectomy was performed [Figure 5]. After surgery, BHCG became negative and histopathology reported a retained placenta increta involving the lower uterine segment without atypical trophoblastic cells [Figure 6].


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)

Mixed echo lesion in the uterine cavity
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Mixed echo lesion in the uterine cavity
Mentions: A 32-year-old gravid 3, para 2 woman with a history of one prior cesarean section was referred to the Department of Obstetrics and Gynecology because of continuous vaginal bleeding from 3 weeks ago. The present gravidity was conceived spontaneously; it was detected in the 12th week of gestation. Physical examination and gynecologic examination of the vulva and vagina were normal. The cervix was long and rigid and mild vaginal bleeding was detected. Vaginal ultrasonography demonstrated a mass in the uterus and it was suspected to be gestational sac without fetal pole, with one of the differential diagnoses being molar pregnancy. Dilatation and curettage was down for patients and some tissue was extracted. In the curettage, she has severe vaginal bleeding that was immediately controlled with oxytocin and misoprostol. After 2 days, she was discharged from the hospital without any problems. The D&C pathology report was placenta velocity. After 1.5 months, she returned with continuance minimal and intermittent vaginal bleeding. In the physical examination, she was anemic but had stable hemodynamic, her uterine size about 14 weeks with soft and nontender uterus, cervix was closed and vaginal bleeding was less than menses period. Transvaginal sonography indicated that the uterine size was 101 mm* 50 mm * 72 mm, the endometrial thickness was about 6 mm and the mixed echo lucent lesion was 48 mm * 52 mm in myometrial thickness of the lower segment alike hydatiform mole [Figure 4] and serum BHCG was 55 mUI/mL. Based on the history and sonography findings, the differential diagnosis included either a trophoblastic tumor, especially placental site trophoblastic tumor, or a uterine myoma with degeneration. A total abdominal hysterectomy was performed [Figure 5]. After surgery, BHCG became negative and histopathology reported a retained placenta increta involving the lower uterine segment without atypical trophoblastic cells [Figure 6].

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