This is a case report of a retained placenta which was successfully removed using nitroglycerin spray.
Human ; Female ; Adult ; PLACENTA, RETAINED ; ANESTHESIA ; ANESTHESIA, CONDUCTION ; NITROGLYCERIN ; ; ;

Uterine sacculation is a very rare complication associated with pregnancy in which a part of the uterine wall balloons, and it is difficult to diagnose because it is usually asymptomatic. It frequently contains the placenta and sometimes may be involved with the trapped placenta after delivery due to its structural characteristic. It is impossible to remove the retained placenta in the sac by using usual methods such as manual delivery or curettage so most of patients with it end up with having a laparotomy. Especially, if the placenta in it is accompanied by abnormal adherence of the placenta or serious hemorrhage, hysterectomy should be considered. Currently several conservative methods for the retained placenta including selective uterine artery embolization and administration of methotrexate have been introduced and these may be tried to treat the retained placenta in the uterine sacculation for avoiding operation and preserving future reproductive potential in selective cases. We experienced a case of placenta increta in the uterine sacculation that was diagnosed first during cesarian section and was treated with selective uterine artery embolization followed by methotrexate administration. This case is reported with a brief review of the literatures.
Curettage ; Hemorrhage ; Humans ; Hysterectomy ; Laparotomy ; Methotrexate ; Placenta Accreta* ; Placenta* ; Placenta, Retained ; Pregnancy ; Uterine Artery Embolization

Uterine sacculation is a very rare complication associated with pregnancy in which a part of the uterine wall balloons, and it is difficult to diagnose because it is usually asymptomatic. It frequently contains the placenta and sometimes may be involved with the trapped placenta after delivery due to its structural characteristic. It is impossible to remove the retained placenta in the sac by using usual methods such as manual delivery or curettage so most of patients with it end up with having a laparotomy. Especially, if the placenta in it is accompanied by abnormal adherence of the placenta or serious hemorrhage, hysterectomy should be considered. Currently several conservative methods for the retained placenta including selective uterine artery embolization and administration of methotrexate have been introduced and these may be tried to treat the retained placenta in the uterine sacculation for avoiding operation and preserving future reproductive potential in selective cases. We experienced a case of placenta increta in the uterine sacculation that was diagnosed first during cesarian section and was treated with selective uterine artery embolization followed by methotrexate administration. This case is reported with a brief review of the literatures.
Curettage ; Hemorrhage ; Humans ; Hysterectomy ; Laparotomy ; Methotrexate ; Placenta Accreta* ; Placenta* ; Placenta, Retained ; Pregnancy ; Uterine Artery Embolization

Placenta increta is a kind of placental adhesion which can cause severe postpartum hemorrhage and life-threatening condition. It might necessitate a hysterectomy, but conservative management can be considerable for preserving reproductive potential when possible. A 34-years-old woman in her 41st week of pregnancy had normal full term spontaneous delivery. Retained placenta after removal by placenta forceps resulted in mild bleeding. Placenta increta was clinically diagnosed on computerized tomography. Remnant placenta in situ was nearly disappeared 2 months later after five-time intramuscular injection of 50 mg methotrexate and three-times curettage was done for conservative management.
Curettage ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Injections, Intramuscular ; Methotrexate ; Placenta ; Placenta Accreta ; Placenta, Retained ; Postpartum Hemorrhage ; Pregnancy ; Surgical Instruments

The objective of this study was to evaluate the duration of retained placenta (RP) on postpartum diseases and culling in dairy cows. Data were collected from 456 Holstein cows between 2008 and 2010. RP (> or = 24 h after parturition) and postpartum diseases were diagnosed by farm managers and a veterinarian according to standardized definitions. The overall incidence rate of RP was 14.0%, and the incidence rate of RP with fourth and higher parity was two times that of cows having offspring for the first time. The duration of RP was 2 to 15 days with a mean of 6.8 days, except for cases of fourth and higher parity which had a mean of 10.5 days. A total of 63% of cows with RP had postpartum diseases. Among the cows diagnosed with RP, 23.4% developed metritis, and of those, 35.3% developed endometritis or pyometra. A total of 25% (n = 16) cows with RP were culled within 60 days in milk (DIM) and of those culled, 75% (n = 12) had postpartum diseases. These results suggest that RP increases the risk of postpartum diseases such as metritis and mastitis and is a culling hazard up to 60 DIM.
Endometritis ; Female ; Humans ; Incidence ; Mastitis ; Milk ; Parity ; Placenta, Retained ; Postpartum Period ; Pyometra ; Veterinarians

Calving records of Holstein dairy cows from 2005 to 2010 comprising Goyang and Paju cities herd with 2,362 calving events representing 240 twin births were used to evaluate the effect of abomasal displacement and retained placenta after single or twin births on fertility. In retained placenta cows, the period of twin pregnancy (mean 270.5 days) was shorter than that of single pregnancy (mean 274.8 days), however first artificial insemination period (twin: mean 107.4 days, single: mean 92.0 days), non-pregnant period (twin: 154.8 days, single: 132.2 days), and number of insemination (twin: mean 2.00 times, single: mean 1.87 times) of twin pregnancy were increased as compared with single pregnancy. In abomasal displacement cows, first artificial insemination period (twin: mean 122.9 days, single: mean 106.0 days), non-pregnant period (twin: 172.4 days, single: 152.0 days), and number of insemination (twin: mean 2.16 times, single: mean 1.89 times) of twin pregnancy were increased as compared with single pregnancy. The prevalence of complication such as retained placenta, abomasal displacement with single or twin births increased first artificial insemination period, non-pregnant period, and number of insemination period.
Displacement (Psychology) ; Fertility ; Humans ; Insemination ; Insemination, Artificial ; Korea ; Parturition ; Placenta, Retained ; Pregnancy ; Pregnancy, Twin ; Prevalence ; Twins

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.
Chorionic Villi ; Fertility ; High-Intensity Focused Ultrasound Ablation ; Humans ; Methods ; Myoma ; Placenta, Retained* ; Ultrasonography* ; Uterine Hemorrhage

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.
Chorionic Villi ; Fertility ; High-Intensity Focused Ultrasound Ablation ; Humans ; Methods ; Myoma ; Placenta, Retained* ; Ultrasonography* ; Uterine Hemorrhage

OBJECTIVE: To compare the effectiveness of oral misoprostol with vaginal misoprostol administration in mid-trimester pregnancy termination after pretreatment with serial laminarias tenting. METHODS: This study was made in 50 patients for mid-trimester pregnancy termination at Department of Obstetrics and Gynecology, Chonbuk National University Hospital from January 1999 through December 2002. Twenty five women received misoprostol orally in a dose of 200 micro gram every hour for 3 doses followed by 400 micro gram every 4 hours after serial laminarias tenting. Twenty five women received misoprostol vaginally in a dose of 400 micro gram every 4 hours after serial laminarias tenting. Side effects of drug, induction to delivery interval, delivery numbers within 24 hours, curettage numbers for retained placenta, and the length of hospital stay were compared. RESULTS: The mean time of induction to delivery interval was significantly shorter in the vaginal group (15.5 +/- 12.7 vs 24.2 +/- 14.3 hours, p<0.01). The length of hospital stay was also shorter in the vaginal group (38.9 +/- 13.1 vs 47.2 +/- 14.5 hours, p<0.01). The number of patients delivered within 24 hours was more in the vaginal group (92 vs 72%, p<0.05). The side effects of misoprostol were slightly more common in the oral group than the vaginal group without statistical significance. CONCLUSION: We suspect that after serial tenting of laminarias, intravaginal misoprostol appears to be more safe and effective than oral misoprostol for mid-trimester termination.
Curettage ; Female ; Gynecology ; Humans ; Jeollabuk-do ; Laminaria ; Length of Stay ; Misoprostol* ; Obstetrics ; Placenta, Retained ; Pregnancy*

We determined the threshold proportion of polymorphonuclear leukocytes (PMNs) for a diagnosis of cytological endometritis (CEM), the risk factors for this condition, and its impact on reproductive performance in dairy cows. Uterine cytology was performed on 407 Holstein cows 4 weeks postpartum to determine the proportions of endometrial cells and PMNs. A receiver operator characteristics curve was used to determine the threshold above which the PMN proportion affected the likelihood of cows conceiving by 200 days postpartum. The optimal threshold was ≥ 14% PMN (sensitivity, 31.3%; specificity, 81.7%; p < 0.05). The farm identity, retained placenta (odds ratio [OR] = 1.87), and septicemic metritis (OR = 3.07) were risk factors for CEM (p < 0.05). Cows with CEM were less likely to resume cyclicity (OR = 0.58) and to conceive by 200 days postpartum (hazard ratio = 0.58). Cows with CEM tended (p < 0.1) to be less likely to become pregnant after their first insemination (OR = 0.65) and to require a greater number of inseminations per conception (2.3 vs. 2.2). In conclusion, a PMN threshold of 14% defined the presence of CEM at 4 weeks postpartum. The farm, retained placenta, and septicemic metritis were risk factors for CEM, which reduces subsequent reproductive performance.
Agriculture ; Diagnosis ; Endometritis ; Female ; Fertilization ; Insemination ; Neutrophils ; Periodicity ; Placenta, Retained ; Postpartum Period ; Risk Factors ; Sensitivity and Specificity