A Case Report and Literature Review of Midtrimester Termination of Pregnancy Complicated by Placenta Previa and Placenta Accreta

Abstract

Objective Concurrent placenta previa and placenta accreta increase the risk of massive obstetric hemorrhage. Despite extensive research on the management of placenta previa (including placenta accreta, increta, and percreta), the number and quality of previous studies are limited. We present a case of placenta accreta requiring an induced second-trimester abortion because of premature rupture of the membranes (PROM). Study Design Case report and review of the literature. Results A 41-year-old female presented at 20 weeks of gestation with placenta previa and PROM. Ultrasonography revealed placenta accreta with multiple placental lacunae. She then developed massive hemorrhaging just prior to a planned termination of pregnancy. We performed a hysterectomy with the intent of preserving life because of the failure of the placenta to detach and blood loss totaling 4,500 mL. Conclusion Previous studies suggest that second-trimester pregnancy terminations in cases of placenta previa which are not complicated with placenta accreta do not have a particularly high risk of hemorrhage. However, together with our case, the literature suggests that placenta previa complicated with placenta accreta presents a significant risk of hemorrhage both during delivery and intraoperatively. Further reports are needed to evaluate the most appropriate treatment options.

Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness

“…A planned CD hysterectomy with or without UAE or UAL was performed in two PC, nine PI and seven PP. 20,22,32,[35][36][37][38][39]41,46,48,52,53 In the other 20 cases a conservative management was attempted including FMR with or without suture or MTX 29,31,34,43,46,50 uterine curettage 55 and the placental left in situ with MTX or UAE. 25,27,28,30,41,42,[45][46][47]49,51 The conservative management was unsuccessful in 12 cases, including five PC, 6 PI and one PP, and required a secondary hysterectomy.…”

“…25,27,28,30,41,42,[45][46][47]49,51 The conservative management was unsuccessful in 12 cases, including five PC, 6 PI and one PP, and required a secondary hysterectomy. 25,27,28,30,34,41,42,44,45,49,55 A dissection or partial resection of the bladder was required in four cases of PP. 33,35,42,54 The mean gestational age at delivery was 30.6 weeks (SD: 7.5; range 15-39 weeks).…”

Placenta accreta located in the posterior wall of the uterus: a case report

“…After the termination of the pregnancy, they had to apply hysterectomy to the patient because of continuous vaginal bleeding. The pathologic examination of the hysterectomy material yielded the diagnosis of placenta accrete [21]. In our case, doppler ultrasonography resulted in a hyperechoic lesion, having intense blood flow, on the posterior uterine wall; when the patient admitted to our clinic one month after from the evacuation procedure, with the complaint of vaginal bleeding.…”

Effects of prophylactic uterine artery embolization on second‐trimester induced abortions in patients with placenta previa

“…23 Therefore, in clinical practice, attention should be paid to the screening of placenta accreta among the patients with placenta previa. 23 Therefore, in clinical practice, attention should be paid to the screening of placenta accreta among the patients with placenta previa.…”

“…However, placenta previa complicated by placenta accreta has been reported to present a considerable risk of hemorrhage during delivery and intraoperatively. 23 Therefore, in clinical practice, attention should be paid to the screening of placenta accreta among the patients with placenta previa. UAE proved to be a safe and effective tool for the management of primary postpartum hemorrhage associated with placenta accreta.…”