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A Case Report and Literature Review of Midtrimester Termination of Pregnancy Complicated by Placenta Previa and Placenta Accreta.

Matsuzaki S, Matsuzaki S, Ueda Y, Tanaka Y, Kakuda M, Kanagawa T, Kimura T - AJP Rep (2014)

Bottom Line: She then developed massive hemorrhaging just prior to a planned termination of pregnancy.We performed a hysterectomy with the intent of preserving life because of the failure of the placenta to detach and blood loss totaling 4,500 mL.Conclusion Previous studies suggest that second-trimester pregnancy terminations in cases of placenta previa which are not complicated with placenta accreta do not have a particularly high risk of hemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.

ABSTRACT
Objective Concurrent placenta previa and placenta accreta increase the risk of massive obstetric hemorrhage. Despite extensive research on the management of placenta previa (including placenta accreta, increta, and percreta), the number and quality of previous studies are limited. We present a case of placenta accreta requiring an induced second-trimester abortion because of premature rupture of the membranes (PROM). Study Design Case report and review of the literature. Results A 41-year-old female presented at 20 weeks of gestation with placenta previa and PROM. Ultrasonography revealed placenta accreta with multiple placental lacunae. She then developed massive hemorrhaging just prior to a planned termination of pregnancy. We performed a hysterectomy with the intent of preserving life because of the failure of the placenta to detach and blood loss totaling 4,500 mL. Conclusion Previous studies suggest that second-trimester pregnancy terminations in cases of placenta previa which are not complicated with placenta accreta do not have a particularly high risk of hemorrhage. However, together with our case, the literature suggests that placenta previa complicated with placenta accreta presents a significant risk of hemorrhage both during delivery and intraoperatively. Further reports are needed to evaluate the most appropriate treatment options.

No MeSH data available.


Related in: MedlinePlus

(a) Histopathological study of the placenta that failed to deliver spontaneously following cesarean section. The surgery was converted to open hysterectomy. The white arrow indicates the abnormal adherence between the uterine myometrium and placenta. (b) Histopathological analysis of the placenta at 20 weeks of gestation, confirming placenta previa complicated by placenta accreta in the sections numbered 3–6.
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FI140043-2: (a) Histopathological study of the placenta that failed to deliver spontaneously following cesarean section. The surgery was converted to open hysterectomy. The white arrow indicates the abnormal adherence between the uterine myometrium and placenta. (b) Histopathological analysis of the placenta at 20 weeks of gestation, confirming placenta previa complicated by placenta accreta in the sections numbered 3–6.

Mentions: The patient opted for TOP because of the poor neonatal prognosis associated with second-trimester PROM and a desire to preserve her uterus. We then counseled the patient on the risk of TOP complicated by placenta accreta. The patient was offered either conventional TOP using intravaginal gemeprost or feticide. She chose the former, and informed consent was obtained. Prophylactic uterine embolization before TOP was also declined. During the TOP, the patient developed severe hemorrhaging with a blood loss of approximately 850 mL. After further 30 minutes, blood loss increased to 1,200 mL. Her cervix was dilated 1 cm, and continuation of TOP was considered too dangerous. Therefore, we decided to perform cesarean delivery via a vertical uterine incision and delivered a stillborn male weighing 190 g. Massive hemorrhaging then occurred, and the placenta did not spontaneously deliver because of the abnormal adherence. At this point, the total blood loss from the placental site was estimated to be 2,000 mL, and we decided that the safest course of action was to perform a hysterectomy, which was completed without further complications. The excised uterus revealed multiple myomas and an abnormal circumferential adhesion between the placenta and the uterine wall, suggesting placenta accreta. Later, histopathological analysis confirmed the diagnosis of placenta accreta associated with multiple myomas (Fig. 2a and 2b).


A Case Report and Literature Review of Midtrimester Termination of Pregnancy Complicated by Placenta Previa and Placenta Accreta.

Matsuzaki S, Matsuzaki S, Ueda Y, Tanaka Y, Kakuda M, Kanagawa T, Kimura T - AJP Rep (2014)

(a) Histopathological study of the placenta that failed to deliver spontaneously following cesarean section. The surgery was converted to open hysterectomy. The white arrow indicates the abnormal adherence between the uterine myometrium and placenta. (b) Histopathological analysis of the placenta at 20 weeks of gestation, confirming placenta previa complicated by placenta accreta in the sections numbered 3–6.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4502619&req=5

FI140043-2: (a) Histopathological study of the placenta that failed to deliver spontaneously following cesarean section. The surgery was converted to open hysterectomy. The white arrow indicates the abnormal adherence between the uterine myometrium and placenta. (b) Histopathological analysis of the placenta at 20 weeks of gestation, confirming placenta previa complicated by placenta accreta in the sections numbered 3–6.
Mentions: The patient opted for TOP because of the poor neonatal prognosis associated with second-trimester PROM and a desire to preserve her uterus. We then counseled the patient on the risk of TOP complicated by placenta accreta. The patient was offered either conventional TOP using intravaginal gemeprost or feticide. She chose the former, and informed consent was obtained. Prophylactic uterine embolization before TOP was also declined. During the TOP, the patient developed severe hemorrhaging with a blood loss of approximately 850 mL. After further 30 minutes, blood loss increased to 1,200 mL. Her cervix was dilated 1 cm, and continuation of TOP was considered too dangerous. Therefore, we decided to perform cesarean delivery via a vertical uterine incision and delivered a stillborn male weighing 190 g. Massive hemorrhaging then occurred, and the placenta did not spontaneously deliver because of the abnormal adherence. At this point, the total blood loss from the placental site was estimated to be 2,000 mL, and we decided that the safest course of action was to perform a hysterectomy, which was completed without further complications. The excised uterus revealed multiple myomas and an abnormal circumferential adhesion between the placenta and the uterine wall, suggesting placenta accreta. Later, histopathological analysis confirmed the diagnosis of placenta accreta associated with multiple myomas (Fig. 2a and 2b).

Bottom Line: She then developed massive hemorrhaging just prior to a planned termination of pregnancy.We performed a hysterectomy with the intent of preserving life because of the failure of the placenta to detach and blood loss totaling 4,500 mL.Conclusion Previous studies suggest that second-trimester pregnancy terminations in cases of placenta previa which are not complicated with placenta accreta do not have a particularly high risk of hemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.

ABSTRACT
Objective Concurrent placenta previa and placenta accreta increase the risk of massive obstetric hemorrhage. Despite extensive research on the management of placenta previa (including placenta accreta, increta, and percreta), the number and quality of previous studies are limited. We present a case of placenta accreta requiring an induced second-trimester abortion because of premature rupture of the membranes (PROM). Study Design Case report and review of the literature. Results A 41-year-old female presented at 20 weeks of gestation with placenta previa and PROM. Ultrasonography revealed placenta accreta with multiple placental lacunae. She then developed massive hemorrhaging just prior to a planned termination of pregnancy. We performed a hysterectomy with the intent of preserving life because of the failure of the placenta to detach and blood loss totaling 4,500 mL. Conclusion Previous studies suggest that second-trimester pregnancy terminations in cases of placenta previa which are not complicated with placenta accreta do not have a particularly high risk of hemorrhage. However, together with our case, the literature suggests that placenta previa complicated with placenta accreta presents a significant risk of hemorrhage both during delivery and intraoperatively. Further reports are needed to evaluate the most appropriate treatment options.

No MeSH data available.


Related in: MedlinePlus