Placenta increta complicating a first-trimester abortion. A case report

Placenta increta complicating pregnancy in the first trimester is rare. A patient with risk factors for placenta increta required a hysterectomy to control a hemorrhage after a first-trimester abortion. Pathologic study confirmed the preoperative diagnosis of placenta increta.

Unexplained positive/elevated maternal serum alpha-fetoprotein associated with placenta increta. A case report

Maternal serum alpha-fetoprotein (MSAFP) is a regularly utilized antenatal screening test for the identification of pregnancies at increased risk for a variety of genetic and nongenetic abnormalities. Complete mid-trimester evaluation of the patient with a positive screening test may fail to reveal an etiology for a positive MSAFP value. This case report concerns an unexplained positive/elevated MSAFP screening test for a patient found at delivery to have abnormal placentation.

Inadvertent administration of prostaglandin E1 instead of prostaglandin F2 alpha in a patient with uterine atony and hemorrhage

A woman underwent cesarean delivery for premature labor, breech presentation, and ruptured membranes. Placenta accreta associated with uterine atony and severe hemorrhage was diagnosed. Prostaglandin E1 instead of prostaglandin F2 alpha was inadvertently administered in an effort to control the hemorrhage. The resulting complications included profound hypotension, disseminated intravascular coagulation, and ventricular tachycardia.

Placenta percreta invading the urinary bladder

The case of a woman with a placenta percreta invading the urinary bladder treated by hysterectomy and partial bladder resection is presented. It is emphasized that if physicians in an emergency clinic are aware of this rare condition, preoperative diagnosis can be made and surgical intervention may be accomplished under ideal conditions.

Massive obstetric hemorrhage due to placenta previa/accreta with prior cesarean section

There is a high association between anterior placenta previa, placenta accreta and previous cesarean section. We report three cases which illustrate the particular danger of massive hemorrhage posed by placenta previa/accreta in a scarred uterus. As the incidence of cesarean section continues to rise worldwide, the problem of placenta previa/accreta is likely to become more common. We emphasize the need for each obstetric unit to have a protocol for dealing with massive hemorrhage.

[Treatment of uterine bleeding due to adherent placenta by intrauterine suturing]

We have tried to suture the wound surface in order to check uterine bleeding due to adherent placenta and placenta accreta at the time of cesarean section to preserve the reproductive function of the uterine. Of the 15 patients 13 had active bleeding from the sinusoid at the site of placental attachment: 2 were placenta accreta with bleeding after removal of local site of implantation. No bleeding occurred after the suturing for a follow-up period of 1 to 3 years. The postpartum course was uneventful. This operation is a simple and useful method to check uterine bleeding in cases of adherent placenta and placenta accreta. The procedure indications and important points to be noticed was discussed.

Logothetopulos pack for the management of uncontrollable postpartum hemorrhage

This is the first reported case in which a Logothetopulos pack was utilized to achieve pelvic hemostasis in a patient requiring a cesarean hysterectomy for placenta accreta with postpartum hemorrhage. The Logothetopulos pack is an easily constructed gauze tamponade method that proved to be life-saving in this case.

[Late hemorrhage as an unusual complication of placenta increta. A clinical case]

A 26 year old patient is urgently submitted to cesarean section for acute fetal pain. After 23 days, hysterectomy has been performed because of haemorrhagic shock. The pathology revealed a placenta increta. The lack of risk factors and the long, asymptomatic period between delivery and haemorrhage make this case noteworthy.

Postabortal hemorrhage due to placenta increta: a case report

Placenta accreta is defined as a condition involving an abnormal adherence of the placenta to the myometrium. It is rare for placenta accreta to present before 20 weeks' gestation; only eight cases have been previously reported. This case report describes a first-trimester placenta accreta which presented during suction curettage for missed abortion. The major risk factors for placenta accreta are related to previous uterine trauma. Considering the rising rate of operative births in the United States, it is possible that the incidence of placenta accreta in early gestation will increase.

Early spontaneous rupture of the post myomectomy gravid uterus

Rupture of a pregnant uterus is a serious threat to the mother's life and her fetus. Most of these cases have predisposing factors of which a post myomectomy scar is rare. Rupture of a post myomectomy gravid uterus usually occurs in the third trimester of pregnancy or during labor. We present a case of a very early spontaneous rupture which occurred at the 20th week of gestation in a post myomectomy uterus. To the best of our knowledge no previous report of a ruptured myomectomy scarred uterus has been described at such an early stage.

Packing of lower uterine segment for control of postcesarean bleeding in instances of placenta previa

Hemorrhage remains a serious obstetric complication with uterine atony as its most common cause. Postpartum atony is controlled with oxytocics and prostaglandins. Uterine arterial ligation is used to decrease the degree of postpartum hemorrhage. Hypogastric arterial ligation and hysterectomy are used when conservative measures fail. With placenta previa accreta, the aforementioned techniques are often not successful in the control of bleeding in the lower segment. The technique of packing of the lower uterine segment is described for use when local control of bleeding points is unsuccessful and hysterectomy is contemplated. Preservation of reproductive potential may be accomplished with this technique with minimal maternal morbidity.

Placenta percreta induced uterine rupture and resulted in intraabdominal abortion

Acute abdomen and shock are diagnosed in a 21-year-old primigravid patient at 23 weeks' gestation. Laparotomy revealed a 7 to 8 cm rupture on the fundus of the uterus and a 450 gm dead fetus in the abdominal cavity.

Placenta percreta invading the urinary bladder

The placenta, normally confined to the decidual lining of the uterine cavity, can in some circumstances invade the muscular wall of the uterus, a condition known as placenta accreta. Less common is placenta increta, in which placental cotyledons become intertwined with the muscular stroma of the uterus. Placenta percreta, in which the trophoblastic tissues penetrate the serosa of the uterus and may extend directly to adjacent structures, is even more rare and is potentially life-threatening. There have been only 10 reports of direct invasion of placenta percreta into the urinary bladder. We review these cases and report 3 recent patients, one of whom was diagnosed pre-operatively by ultrasonography.

Spontaneous uterine rupture in late pregnancy caused by placenta percreta: a case report

Placenta percreta is a rare but a serious complication of pregnancy. A case of spontaneous rupture of uterus at 32 weeks of gestation due to Placenta percreta is reported. A total abdominal hysterectomy was carried out.

Placenta percreta invading the bladder: report of 2 cases

We report 2 cases of placenta percreta with invasion of the bladder that resulted in massive hemorrhage at cesarean section. Control was achieved by hysterectomy, bilateral internal iliac artery ligation, suture ligation of bleeding vessels and bladder repair, with no fetal or maternal mortality.

Vesicouterine fistula associated with placenta percreta

Vesicouterine fistulas are uncommon acquired urogenital fistulas. A case of a vesicouterine fistula associated with placenta percreta is presented.

[Placenta percreta: a danger in pregnancy]

Repeated massive bladder haemorrhages of a patient during the 22nd week of her third pregnancy was treated symptomatically for more than three weeks. The cause of the bleeding could not be found. Only the knowledge of the clinical features of a placenta percreta led to the survival of the patient.

Occult infiltrating placenta previa percreta: an unusual case highlighting the management problems in a young patient

Placenta previa in association with placenta accreta has been recorded on average in 1 in 500 pregnancies; its association with placenta percreta is a much rarer condition. We report an unusual case of placenta previa which presented as a severe form of occult parasitic infiltration, invading the internal iliac vessels. This was followed by life-threatening complications, despite preventative measures. Use of a prediction index to suspect placenta previa is mentioned.

Acute abdomen due to placenta percreta

Placenta percreta is a rare but serious complication of pregnancy, usually presenting itself in the third trimester. The incidence of fetal death and maternal mortality is high. We report a case presenting as an acute abdomen, due to haemoperitoneum at 33 weeks of pregnancy. Incidence, etiology, diagnosis and treatment are discussed, and the literature is reviewed.

Acute abdomen caused by placenta percreta in the second trimester

A woman with a history of "in utero" diethylstilbestrol exposure but no prior uterine surgery presented with an acute abdomen at 21 weeks' gestation. She had hemoperitoneum associated with placenta percreta.

Placenta accreta: a problem of increasing clinical significance

Placenta accreta in association with placenta previa and previous cesarean delivery is a condition of increasing clinical significance. A case report of a woman with placenta percreta is presented. Risk factors, incidence, and management are discussed. Recommendations for preoperative and intraoperative management are presented.

Uterine inversion secondary to placenta accreta in a diethylstilbestrol-exposed parturient. A case report

The potential for a poor reproductive outcome is particularly pronounced in women with cervicovaginal changes related to diethylstilbestrol (DES). A women with documented DES exposure and cervicovaginal abnormalities developed an acute postpartum uterine inversion requiring a hysterectomy.

Abnormally adherent placentation: a life-threatening complication

Two cases are presented illustrating the potential danger of abnormal placentation. Placenta accreta is frequently associated with placenta praevia and/or a history of previous caesarean section. As there are no obvious specific symptoms before or during delivery, one should consider the possibility of this anomaly in the third stage of labour when manual removal of the placenta is very arduous. The treatment of choice is immediate abdominal hysterectomy, for this is followed by the lowest maternal mortality. If abnormal placentation is suspected, one should be prepared to deal with it as necessitated, including the possible performance of an emergency caesarean hysterectomy.