English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Background: Abnormal placental implantation (API) is an uncommon obstetrical phenomenon that is associated with significant maternal morbidity. Typically, the diagnosis of API is made at the time of delivery in the third trimester. However there are reports of API presenting in the second trimester, and rarely in the first trimester. Cesarean Scar Pregnancy (CSP) can be considered a subset of API. Early API rarely occurs in the absence of previous uterine manipulation. CSP is always associated with previous cesarean delivery. Nonetheless, it has been suggested that CSP and early API are histologically indistinguishable and both are precursors of API. Case Report: A 38 yo G4P2012 with a history of two previous cesarean sections underwent a dilation curettage and evacuation (DC&E) procedure at 14w6d gestational age (GA) dated by last menstrual period (LMP) after approximately one month of expectant management for an incomplete spontaneous abortion. Beta-hCG on the morning of surgery was 1,936 mIU/mL. In the operating room (OR), immediately after the bimanual exam was performed heavy bright red vaginal bleeding was noted to be coming from the cervical os. A steady heavy flow of bleeding continued throughout the procedure. Intra-operatively the patient became hypotensive and was transfused with two units of packed red blood cells. Uterotonic agents were administered and a Bakri balloon was placed to tamponade the bleeding. At the conclusion of the case no further active bleeding was noted and the patient was hemodynamically stable. Approximately 7-8 hours after the initial DC&E procedure the patient bled around the Bakri balloon and was noted to be tachycardic. About nine hours after the initial surgery the decision was made to return to the OR due to persistent vaginal bleeding, persistent tachycardia, additional blood product requirements, and re-review of early transvaginal ultrasound which showed heterogeneous myometrium and a heterogeneous mass-like solid and cystic appearing area in the lower uterine segment. A total abdominal hysterectomy, bilateral salpingectomy and cystoscopy were performed. Intra-operative evaluation revealed a firm protruding tissue mass in the left anterior lower uterine segment that was found to be placenta increta or more on final pathology. The patient recovered appropriately during her hospital stay and was discharged in stable condition. Conclusion: API is an uncommon finding in early pregnancy. Although there are few reported cases, the majority of documented cases presented similarly to our case. Although specific screening for API or CSP is not recommended, it is important to have a high index of suspicion and proper preparation for patients with multiple risk factors for API, especially previous cesarean sections. It is important to consider early API and CSP as differential diagnoses when one encounters unexplainable and unexpected hemorrhage at the time of DC&E procedure.

Placenta Increta at 14 Weeks with Subsequent Hysterectomy: A Case Report