Successful management of total placenta previa with placenta accreta presenting with massive obstetric hemorrhage: A case report

The third stage of labor (delivery of the placenta), per current definition, takes place within 30 minutes of fetal delivery in a nulliparous or multiparous woman. According to the American Pregnancy Association, a retained placenta is diagnosed if the placenta is not delivered within 30 minutes following delivery of the fetus. Retained placenta can be caused by placenta accreta, increta, or percreta. There are several complications of a retained placenta, including postpartum hemorrhage, which can lead to maternal death if not treated promptly. We report the case of a 32-year-old female, gravida 4 para 3, who was diagnosed with a retained placenta after delivering at term (39 weeks gestation). The retained placenta was complicated by postpartum hemorrhage and was treated within 15 minutes of fetal delivery with several uterotonics (misoprostol, oxytocin, carboprost, and tranexamic acid) and several passes of ultrasound-guided suction curettage. Sharp curettage was also used with ultrasound to confirm that the uterus was empty, followed by one more suction curettage to remove any products of conception that were scraped off with sharp curettage. Vaginal bleeding was significantly reduced; minor bleeding was noted from a first-degree vaginal laceration, which was repaired by suture. The patient recovered from surgery and was discharged on postpartum day 3 with her neonate in stable condition. In conclusion, this case highlights that retained placenta is a serious obstetric complication that can cause life-threatening postpartum hemorrhage. More data are needed to define the period of time correlating with the greatest chance of encountering a retained placenta in order to improve obstetric care and reduce maternal morbidity and mortality. Future research should consider challenging the current definition of retained placenta, defined as a placenta undelivered after 30 minutes, in favor of a shorter time period, 15 minutes undelivered, in order to mobilize the obstetric team, anesthesiologist, and blood bank to prevent catastrophic postpartum hemorrhage.

Section: Discussionmentioning

confidence: 99%

Retained Placenta and Postpartum Hemorrhage: A Case Report and Review of Literature

Lekuikeu¹,

Moreland²

2022

“…In order to preserve fertility, conservative measures are recommended before drastic procedures. Uterotonic medicines, intrauterine packing (Bakri balloon), external compression with uterine sutures (B-Lynch), and selective devascularization by ligation or embolization of the uterine artery are all conservative alternatives for PPH [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

In Vitro Fertilization in a Nulliparous Female Resulting in Placenta Increta and Postpartum Hemorrhage

Kassas¹,

Blue

Brenner³

2021

A 32-year-old female with unexplained infertility delivered a healthy male infant at 39 weeks 0 days gestational age; the pregnancy was facilitated by in vitro fertilization. Shortly after delivery, she was found to have a morbidly adherent placenta. Attempted removal resulted in postpartum hemorrhage and ultimately hysterectomy after attempting multiple fertility preserving methods to achieve hemostatic control. Pathology results revealed a diagnosis of a 0.1 cm placenta increta (Grade 2 placental villi invasion), the least common diagnosis within the placenta accreta spectrum (PAS). Likely due to the small point of trophoblastic invasion, the diagnosis and outcome were not foreseen. This case highlights the need for additional data collection and development of standardized guidelines for the diagnosis and management of PAS, given a patient’s risk factors. Current research may be limited by stigmatization surrounding infertility and reproductive-altering surgeries (e.g. hysterectomy). Additionally, counseling in all stages of pregnancy is critical to achieving the best patient-centered outcomes.

“…Placenta previa is a known risk factor of abnormal placentation along with the history of previous LSCS [ 15 ]. The risk association varies in different series.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study of Placenta Accreta, Percreta, and Increta in Peripartum Hysterectomies in a Tertiary Care Institute in Northeast India

Dutta¹,

Dey²,

Chanu³

et al. 2020

Self Cite

Background: Abnormal placentation such as placenta accreta, increta, and percreta are frequent causes of post-partum hemorrhage, which results in maternal morbidity and mortality. A previous history of cesarean section, placenta previa, and pre-eclampsia are the important risk factors for abnormal placentation. A reliable antenatal diagnosis and planned surgical approach can reduce the incidence of maternal morbidity and mortality from massive hemorrhage. Aim: To study the incidence of abnormal placentation and the association of various risk factors with abnormal placentation. Material and methods: A retrospective study over a period of eight years in patients with peripartum hysterectomies due to abnormal placentation presenting with massive hemorrhage. Results: We received a total of 10 emergency hysterectomy specimens during an eight‑year period. Of the cases, placenta accreta accounted for 40% (4/10), increta up to 40% (4/10), and percreta 20% (2/10). Analysis of these findings with parity showed 20% of the women were uniparous (2/10), and 80% were multiparous (8/10). Risk factor analysis showed previous cesarean sections in 40% (4/10), placenta previa in 50% (5/10), and pre‑eclampsia in 10% (1/10). Conclusion: The present study highlights the incidence of abnormal placentation in a tertiary care institute in Northeast India. Placenta accreta and increta constituted the major forms of abnormal placentation. Multiparous women with placenta previa followed by previous lower segment cesarean section were more at risk of having abnormal placentation. These findings will guide in antenatal care by risk prioritization and management planning of these patients.