Premium
P09.08: Placenta previa accreta invading the urinary bladder
Author(s) -
Onofriescu M.,
Buzgar C.,
Luca A.,
Tanase A.,
Alexandra T.,
Berescu A.
Publication year - 2018
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.19692
Subject(s) - medicine , placenta previa , placenta accreta , obstetrics , caesarean section , gestation , hysterectomy , urinary system , uterine rupture , obstetrics and gynaecology , urinary bladder , pregnancy , gynecology , placenta , uterus , surgery , fetus , genetics , biology , endocrinology
Recently, a new management approach for placenta accreta/increta, which involves conservative management until the placenta spontaneously disappears without hysterectomy, has been reported. With this approach, women can avoid the risk of severe bleeding due to hysterectomy; however, the risk of recurrent placenta accreta/increta after conservative medical treatment remains unclear. We experienced a case of recurrence of placenta accreta/increta after conservative medical treatment for clinical placenta accreta at a previous pregnancy. A 30-year-old woman, gravida 5 para 4, who had undergone two prior Caesarean sections, was admitted to our hospital because of natural conception. During her previous pregnancy, she had induced abortion at 15 weeks’ gestation and been clinically diagnosed with placenta accreta. She had selected conservative management for placenta accreta, and the placenta disappeared after several months. At 28 weeks’ gestations during the present pregnancy, she was clinically suspected of having placenta accreta or increta by ultrasonography and magnetic resonance imaging. The placenta fully covered the internal cervix, and thinning of the myometrium along with flow void was noted, suggesting hyper vascularity around the placenta. She underwent Caesarean hysterectomy at 35 weeks and 2 days’ gestations. Placenta increta was diagnosed by a pathological examination. Conservative management for clinical placenta accreta is safer than hysterectomy, although it may carry a risk of recurrence of placenta accreta/increta if women become pregnant again after conservative management.