Placenta Percreta at 17 Weeks with Consecutive Hysterectomy: A Case Report and Review of the Literature

Abstract

Placenta percreta in early pregnancy is an extremely rare but life-threatening complication, for which very few cases have been reported in the literature worldwide, none from the United States. We report a patient with two previous cesarean deliveries, who presented with incomplete abortion at 17 weeks and underwent dilatation and curettage. She was found to have retained, adherent placenta that led to extensive hemorrhage, requiring emergency supracervical hysterectomy. Postoperative course was also complicated by severe consumption coagulopathy, necessitating reexploration after hysterectomy. Pathology revealed a placenta percreta. Patient lost more than 8000 cc blood through the 2 surgeries, received massive transfusions due to severe disseminated intravascular coagulopathy (DIC), and underwent a complicated surgery because of great difficulty in separating lower uterine segment and cervix from the bladder. Abnormal placentation in early pregnancy has increased in prevalence due to marked rise in cesarean deliveries and curettages in recent decades. We reviewed all reported cases of first and second trimester placenta percreta in the literature, to emphasize the early recognition of abnormal placentations in patients with risk factors, consider prenatal evaluation in such patients, anticipate complicated placental implantations during termination procedures, and prevent associated maternal morbidity and mortality.

Laparoscopic hysterectomy to manage uterine rupture due to placenta percreta in the first trimester: A case report

“…Conservative treatments for placenta percreta remote from delivery have been described, including uterine curettage with packing, primary closure, methotrexate, and uterine vessel occlusion [14,15]. However, there is a four-fold increase in mortality with uterine-sparing treatment compared with hysterectomy [16], with unknown outcomes and potential risks for future pregnancies, and patients often require subsequent hysterectomy for uncontrolled hemorrhage, coagulopathy, or sepsis [18,19,[27], [28], [29], [30]]. Therefore, informed shared-decision making is critical and this patient was counseled on several occasions about management options, including fertility-sparing treatments given her young age and low parity.…”

Placenta acreta en paciente sin antecedentes quirúrgicos uterinos

“…El manejo universalmente aceptado y considerado como método estándar para el tratamiento del acretismo placentario es la histerectomía (3,12,13) . Un estudio realizado en una institución peruana sobre histerectomía puerperal (14) evidenció que la mayoría de estas (37,5%) se debió a acretismo placentario.…”

Urological Manifestations of Placenta Percreta

“…The most important risk factor is the observation of placenta previa (low lying placenta) after a cesarean delivery. Maternal age of 33 or greater, and multiple cesarean deliveries increase the risk for adherent placenta disorders, therefore a detailed past medical history is essential to determine the overall risk and to anticipate complicated placental implantation disorders [10,16,17,18]. Other risk factors for placenta percreta include, submucous myoma, previous curettage, Asherman's syndrome, advanced maternal age, gandmultiparity, smoking, chronic hypertension as well as a pervious history with adherent placenta disorders [18,19].…”

“…Placenta percreta being the most severe form of all implantation disorders requires aggressive evaluation and management to decrease patient morbidity [16]. Literature suggests that placenta percreta can be diagnosed as early as the 11th week of gestation, however the mode diagnosis of placenta percreta was observed at 35 weeks of gestation.…”