During 1st and 2nd trimester, placenta accreta is rarely found and is not easy to diagnosis during these trimester. From time to time placenta accreta is found after induced abortion or spontaneous abortion. We had experienced a case of placenta increta which was found about 50 days after D&C due to missed abortion at local clinic. So we presented it with a brief case history and brief review of the concerned literatures.
Abortion, Induced* ; Abortion, Missed ; Abortion, Spontaneous ; Diagnosis ; Dilatation and Curettage ; Female ; Humans ; Placenta Accreta* ; Placenta* ; Pregnancy

Placenta previa-percreta is a rare but highly morbid condition usually diagnosed clinically, intraoperatively. The cause of placenta accreta is considered to be deficient decidualization and absence of the fibrinous layer of Nitabuch. The condition is usually, but not always, seen in women having previous trauma, eg, cesarean section, manual removal of placenta, or curettage. Magnetic resonance imaging(MRI) might allow antepartum diagnosis of the this condition. Management included cesarean supracervical hysterectomy and bilateral hypogastric arterial ligation, and adjuvant methotrexate administration. We experienced a case of placenta previa percreta at 40 weeks gestational age. Here we present the case with brief review of literature.
Cesarean Section ; Curettage ; Diagnosis ; Female ; Fibrin ; Gestational Age ; Humans ; Hysterectomy ; Ligation ; Methotrexate* ; Placenta Accreta ; Placenta Previa ; Placenta* ; Pregnancy

Placenta increta is a life-threatening complication of pregnancy characterized by invasion of placenta villi into the underlying myometrium. Usually, presentation is in the early postpartum period with hemorrhage during difficult placental removal. Although placenta increta may complicate first and early second-trimester pregnancy loss, this lesion is rarely found, whose diagnosis can be very difficult during these trimester. We had experienced a case of placenta increta which was found about 14 days after dilatation and curettage (D and C) due to missed abortion at private obstetrics' clinic and report this with brief reviewed the literatures.
Abortion, Missed ; Animals ; Diagnosis ; Dilatation and Curettage ; Female ; Hemorrhage* ; Humans ; Mice ; Myometrium ; Placenta Accreta* ; Placenta* ; Postpartum Period ; Pregnancy ; Pregnancy Trimester, First

Placenta percreta occurs when chorionic villi penetrate through the myometrium up to the serosa. The incidence of placenta percreta is extremely rare (about 1/140000 deliveries) but it is accompanied by life threatening complication of pregnancy due to massive hemorrhage. Antepartum diagnosis and proper management is important to decrease the marternal mortality and morbidity. We present two cases of spontaneous uterine rupture due to placenta percreta with brief review of literature. The one is that a women with a history of previous ceasrean section and placenta previa was treated with cesarean hysterectomy due to the spontaneous uterine rupture with placenta percreta at GA 37(+2) weeks. The other is that a women with a bicornuate uterus had preserved the ruptured uterus with placenta percreta incidentally detected at emergency cesarean section at GA 39(+5) weeks.
Animals ; Cesarean Section ; Chorionic Villi ; Diagnosis ; Emergencies ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Mice ; Mortality ; Myometrium ; Placenta Accreta* ; Placenta Previa ; Placenta* ; Pregnancy ; Serous Membrane ; Uterine Rupture* ; Uterus

OBJECTIVE: To evaluate the efficacy of color Doppler ultrasound in diagnosis and management of placenta previa with accreta. METHODS: Hospital records were reviewed all cases of placenta previa from December 1999 to June 2002, and seventy-four patients with placenta previa underwent color Doppler ultrasound in their second and third trimester. Four diagnostic criteria of placenta accreta were diffuse lacunar flow pattern, exhibiting diffusely dilated vascular channels throughout the whole placenta: focal lacunar flow pattern showing irregular sonolucent vascular lakes, regionally or focally within the intraparenchymal placental area: absence of subplacental vascular signals in the areas lacking the peripheral subplacental hypoechoic zone: interphase hypervascularity with abnormal blood vessels linking the placenta to the bladder. RESULTS: Twenty-four of the seventy-four patients diagnosed placenta previa with accreta according to the above criteria and thirteen of these have proven to placenta accreta histopathologically. In ten cases hysterectomy were done under the group of suspicious placenta accreta. The sensitivity, specificity, positive predictive value and negative predictive value were 100%, 83%, 56% and 100%. CONCLUSION: The color Doppler ultrasound was effective method for the diagnosis of placenta previa with accreta, so proper diagnosis will be helpful to management of placenta previa with accreta patients.
Blood Vessels ; Diagnosis* ; Female ; Hospital Records ; Humans ; Hysterectomy ; Interphase ; Lakes ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy ; Pregnancy Trimester, Third ; Sensitivity and Specificity ; Ultrasonography* ; Urinary Bladder

OBJECTIVE: To suggest the pregnancy outcome data according to the types of placenta previa in order to establish the optimal management of placenta previa. METHODS: A retrospective review of the clinical records of 179 women delivered with the diagnosis of placenta previa over 25 gestational weeks during the 6-year period from January 1, 1995 to December 31, 2000, at the Wonju Christian Hospital. We divided each groups into total, partial and marginal placenta previa in order to compare pregnancy outcomes. RESULTS: There were significant differences in the numbers of gravida, prior abortion, number of previous cesarean section between marginal and total placenta previa group. There were no significant differences in the gestational weeks at delivery, blood transfusion units, birth weight and placenta/birth weight ratio among each group. Statistically significant frequent hysterectomy in case of partial palcenta previa in comparison to marginal placenta previa was performed. Significant differences of the prior cesarean section (86.4% vs 3.8%) and placenta accreta (45.4% vs 37.5%) were noted between hysterectomy group and no hysterectomy group. CONCLUSION: Previous cesarean section history is strongly associated with cesarean hysterectomy. Women with placenta previa and history of previous cesarean section have more risk of placenta accreta. So, we should prepare sufficiently for cesarean hysterectomy in such cases.
Birth Weight ; Blood Transfusion ; Cesarean Section ; Diagnosis ; Female ; Gangwon-do ; Humans ; Hysterectomy ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Retrospective Studies

Uterine rupture in the second trimester is rare, but it is a surgical emergency. Also it results rapid deterioration of patient and high mortality despite of prompt therapy and massive transfusion. Radiologic studies often do not allow definitive diagnosis of it, so clinical judgement is critical for optimizing patient care. We present a case of spontaneous uterine rupture with fetal death in 17 weeks of pregnancy due to placenta percreta with brief review of the literature.
Diagnosis ; Emergencies ; Female ; Fetal Death ; Humans ; Mortality ; Patient Care ; Placenta Accreta ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Uterine Rupture*

Cesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Little is known about its incidence and natural history. With increasing incidence of caesarean section worldwide, more and more cases are diagnosed and reported. Transvaginal ultrasound and colour flow Doppler provides a high diagnostic accuracy with very few false positives. A delay in diagnosis and/or treatment can lead to uterine rupture, major haemorrhage, hysterectomy and serious maternal morbidity. Surgical management can be safe and effective and medical treatment can be selected as appropriate selection criteria. Patients with history of a pregnancy in a cesarean delivery scar should be advised of the risk for future uterine rupture and placenta accreta. We experienced a case of ectopic pregnancy with treatment of surgical excision and report with a brief review of literatures.
Cesarean Section ; Cicatrix* ; Diagnosis ; Female ; Humans ; Hysterectomy ; Incidence ; Natural History ; Patient Selection ; Placenta Accreta ; Pregnancy ; Pregnancy, Ectopic* ; Ultrasonography ; Uterine Rupture

BACKGROUNDThe reports on massive transfusions (MTs) in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe postpartum hemorrhage (PPH) and the frequency trends over the past 10 years.

METHODSWe retrospectively analyzed the data of 3552 PPH patients who were at ≥28 weeks of gestation in the Obstetric Department of Peking University First Hospital from January 2006 to February 2015. The clinical records of patients receiving MT with ≥5 units (approximately 1000 ml) of red blood cells within 24 h of giving birth were included. The Pearson's Chi-square and Fisher's exact tests were used to compare the frequency distributions among the categorical variables of the clinical features.

RESULTSOne-hundred six women were identified with MT over the 10-year period. The MT percentage was stable between the first 5-year group (2006-2010) and the second 5-year group (2011-2015) (2.5‰ vs. 2.7‰, χ2 = 154.85, P = 0.25). Although uterine atony remained the main cause of MT, there was a rising trend for placental abnormalities (especially placenta accreta) in the second 5-year group compared with the first 5-year group (34% vs. 23%, χ2 = 188.26, P = 0.03). Twenty-four (23%) women underwent hysterectomy, and among all the causes of PPH, placenta accreta had the highest hysterectomy rate of 70% (17/24). No maternal death was observed.

CONCLUSIONSThere was a rising trend for placental abnormalities underlying the stable incidence of MT in the PPH cases. Placenta accreta accounted for the highest risk of hysterectomy. It is reasonable to have appropriate blood transfusion backup for high-risk patients, especially those with placenta accreta.

Adult ; Blood Transfusion ; Female ; Humans ; Hysterectomy ; Placenta Accreta ; physiopathology ; Postpartum Hemorrhage ; diagnosis ; etiology ; therapy ; Pregnancy ; Retrospective Studies ; Risk Factors

Interstitial pregnancy is a form of ectopic pregnancy in an unusual location, implanting on the intramural part of the fallopian tube. Because the myometrium is highly distensible, it may allow an interstitial pregnancy to advance up to 16 weeks where it usually presents with rupture. Its late diagnosis and severe hemorrhagic complication accounts for a higher mortality rate compared to other ectopics. On the other hand, interstitial pregnancies that progress to term or near term are extremely rare. From the 10 cases published in literature reporting the delivery of a live term or near term fetus, only 1 of these cases has antenatally diagnosed the presence of interstitial pregnancy prior to rupture by investigating a probable placenta accreta found on ultrasound. This report discusses a case of a ruptured full term interstitial pregnancy diagnosed intraoperatively which resulted to a live mother and baby, and describes retrospectively the similar ultrasound findings of placenta accreta which was realized after rupture.

Human ; Female ; Adult ; Pregnancy ; Pregnancy, Interstitial ; Fallopian Tubes ; Placenta Accreta ; Myometrium ; Mothers ; Delayed Diagnosis ; Term Birth ; Fetus