Anterior uterine incarceration complicated by placenta previa and placenta accreta spectrum disorder: a case report

Abstract

Background: Uterine incarceration is a rare obstetric complication that is always associated with retroversion and prone to misdiagnosis. Pelvic examination and imaging methods including ultrasound and magnetic resonance imaging (MRI) are used as the primary diagnostic tool. We present an asymptomatic anterior uterine incarceration complicated by placenta previa and placenta accreta spectrum (PAS) disorder, which could be diagnosed during the pregnancy periods, but was first diagnosed during the cesarean section (CS) and got the surgeons into trouble.Case Description: A 28-year-old woman, gravidity 4, parity 1, was hospitalized due to placenta previa and PAS disorder diagnosed by ultrasound and MRI at 35.6 weeks of gestation. She had not experienced any discomfort. Given her history of a previous CS, she underwent a well-prepared cesarean delivery for the termination of the pregnancy. The patient had a series of periodical ultrasound and MRI examinations in which placenta previa and placenta accreta were described in disregard of the abnormal location of cervix; consequently, interior uterine incarceration was first diagnosed during the surgery, which caused significant difficulties in the operation which lasted 3 hours and 21 minutes. The patient developed severe hemorrhaging and lost approximately 5,000 mL of blood. Fortunately, she delivered a health male infant weighing 3,440 grams with quite good Apgar scores. During the follow-up, maternal and child health was confirmed.Conclusions: With regard to patients who have undergone previous pelvic surgery, doctors need to pay close attention to the position of the cervix, the pelvic adhesion situation during the prenatal examination, and be on alert for uterine incarceration. Uterine incarceration can be accurately recognized by periodic sonography and MRI if the radiologist is aware of this unusual condition. We do suggest that special are must be taken to avoid unnecessary trauma by misdiagnosis because of lack of awareness.

Risk factors of emergency cesarean section in pregnant women with severe placenta accreta spectrum: a retrospective cohort study

“…However, in our study, there were only 26 (16.0%) cases of hysterectomy, so we tend to conduct a more detailed preoperative evaluation of patients. In our hospital, the condition of the placenta and uterus was determined by ultrasound and magnetic resonance imaging before surgery, and the placenta was scored through ultrasonographic examination ( 8 , 27–29 ). The accuracy of ultrasound in preoperative diagnosis of PAS reached 83.3–89.6% ( 14 , 25 ), and we only included pregnant women with severe PAS (placental score ≥ 10 by ultrasonic), the PAS diagnosis of the patient is relatively reliable.…”

“…Placenta accreta spectrum is one of the most serious long-term complications of cesarean section, which may result in heavy postpartum hemorrhage. Due to endometrial damage, poor wound healing, and other factors, the villi and placenta are more likely to invade the muscle layer and even the serous layer in PAS patients who undergo cesarean section, resulting in placenta implantation and incomplete separation of the placenta during delivery (7)(8)(9). The rapture of the placental marginal sinus can result in severe bleeding during the operation, leading to severe complications such as disseminated intravascular coagulation, hysterectomy, infection, and even death (10)(11)(12)(13).…”