Trapped Placenta and Conceptus in Uterine Sacculation: Two Rare Case Reports

Abstract

Uterine sacculation is a very rare pregnancy complication having an incidence of about one in 3000 pregnancies. It is more commonly associated with retroverted uterus. Isolated sacculation either congenital or acquired is very rare. Without timely intervention, this can cause miscarriage, intrauterine fetal death, preterm delivery, uterine rupture, adherent/retained placenta and postpartum hemorrhage. Retained placenta is a common complication of congenital sacculation. Acquired sacculation occurs secondary to uterine surgeries, like uterine curettage, hysterotomy, cesarean section or following misoprost use. A rare case of retained placenta in the congenital uterine sacculation, first diagnosed during laparotomy done for failed manual removal of placenta, which was removed by hysterotomy. Another case with failed induction of abortion for intrauterine fetal demise and threatened rupture of acquired sacculation are reported.Awareness and early diagnosis of uterine sacculation allows clinicians to be prepared for emergency situations and better manage complications, to limit fetomaternal morbidity and mortality.Abbreviations: IUGR: Intrauterine growth restriction; IUFD: Intrauterine fetal death.

Uterine Sacculation With Entrapped Placenta After Delivery

“…9,11 Previous published cases of uterine sacculation with entrapped placenta have been managed with immediate hysterotomy and manual placenta removal. [4][5][6][7] Proceeding with laparotomy and hysterotomy in these circumstances may avoid late hemorrhagic 5 or infection complications (case 2). However, operating on the immediately postgravid uterus also carries a risk of hemorrhage and, in some cases, hysterectomy.…”

“…Treatment options that have been proposed include expectant management, methotrexate, uterine artery embolization, dilation and curettage, and hysterotomy. [4][5][6][7] Here we report two cases of uterine sacculation with entrapped placenta within the uterine fundus diagnosed immediately postpartum. One patient was treated with immediate hysterotomy, and the other was managed expectantly but ultimately required hysterotomy.…”