Placenta Percreta in First Trimester Leading to Disseminated Intravascular Coagulopathy (DIC): A Rare Case Report

Abstract

Placenta percreta is the most severe form of abnormal placental attachment. It is a variant of placenta accreta in which chorionic villi penetrate the entire thickness of the myometrium through the uterine serosa and may involve the adjacent structures. Literature review shows very few cases encountered during the first trimester of pregnancy. A-20-year-old woman with previous one cesarean section presented with continuous vaginal bleeding beginning after incomplete abortion at seven weeks and six days period of gestation for which she underwent dilatation and curettage. MRI revealed irregular heterogeneous signal intensity mass with large area of hemorrhage in lower anterior wall extending towards the endometrial cavity suggestive of morbid adherent placenta. Following continuous bleeding after repeated curettage for retained, adherent placenta her coagulation profile got deranged and DIC developed. Correction of coagulopathy and emergency hysterectomy as a life saving measure for placenta percreta was done in our case.

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.…”

CLAP – a new organ-preserving surgery for combined placenta praevia accreta vera into the uterine cicatrix after the previous cesarean section

“…Оскільки проспективних контрольованих досліджень щодо ведення та наслідків пророщення плаценти не існує, єдиним варіантом його дослідження є розгляд окремо опублікованих випадків або серій випадків [4][5][6][7][8].…”

Rotura uterina durante el segundo trimestre de gestación asociado a placenta percreta: presentación de un caso y revisión de la literature

“…[20,[22][23][24][25][26] La mayoría utilizamos la ecografía como método diagnostico principal visualizando líquido libre. Por otra parte, las imágenes por ultrasonido asociado a Doppler color, podrían ser capaces de identificar anomalías en adhesión y de invasión de la placenta en el miometrio y órganos adyacentes como vejiga.…”