Placenta accreta associated with submucosal fibroid polyp

Taiwanese Journal of Obstetrics & Gynecology, 2011

The placenta is adherent to the endometrial lining in normal pregnancies. Penetration beyond this is abnormal and is categorized according to the depth of invasion [1]. The frequency of abnormal placentation varies between 1 in 333 and 1 in 70,000 births with a mean incidence of 1 in 2,500 births [2]. The incidence of placenta accreta has dramatically increased in recent years, which can be attributed to increasing caesarean rate in most countries [3]. The risk factors include a history of placenta previa, caesarean section, dilation and curettage, previous myomectomy, multiparity, elevated maternal age (>35), and erythroblastosis fetalis [4]. Several therapeutic methods are described for placenta accreta, including immediate hysterectomy after delivery, leaving the placenta in site after delivery, methotrexate (MTX) administration, uterine artery embolization, and temporary occlusion of internal iliac artery. In any given case, one or more of these techniques may be used to minimize hemorrhage [1]. In this case report, we are introducing a multidisciplinary approach, which led to uterine preservation. The main purpose of this study was to prove that there is no contraindication in using several methods simultaneously; and if indicated, we can use them together. The patient was a 23-year-old primigravid woman without previous history of uterine surgery or curettage. She was on methyldopa to control her chronic hypertension. Placenta did not expel after normal vaginal delivery of her term pregnancy; however, the patients' vital signs were stable. The patient was taken to the theatre for manual removal of placenta using forceps. Only a small part of the placenta was extracted. After the procedure, she had severe vaginal bleeding (around 700 cc)

Clinical and experimental obstetrics & gynecology, 2013

Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. The authors report a case of placenta accreta in a primiparous patient with multinodular leiofibromyomatosis of the uterus following failed manual removals of a retained placenta. They describe a conservative management in a stable patient desiring future fertility with a unilateral prophylactic uterine artery embolization, a multidose regimen of methotrexate, and a subsequent abdominal myomectomy.

Clinical Obstetrics and Gynecology, 2002

Objective: This study aimed to evaluate the effect of the methylenetetrahydrofolate reductase (MTHFR) polymorphisms as risk factors for obstetrical/perinatal complications. Methods: We reviewed the records of pregnancies screened for MTHFR polymorphisms in our hospital between from January 2002 to December 2012. This cohort study is consisted of 617 patients including 227 patients with homozygous or compound heterozygous MTHFR polymorphisms (Group I), 257 patients with heterozygous polymorphisms (Group II), and 133 patients without MTHFR polymorphisms (Group III). Demographic data, obstetrical history, diagnostic laboratory parameters, pregnancy outcomes were recorded. A new obstetrics index (BOI) was used in order to compare the obstetrical backgrounds of the study groups. Results: We have shown that patients who had homozygous or "compound heterozygous" mutations for MTHFR had adverse perinatal outcomes compared to control patients and patients with heterozygous mutations. We have found that obstetrical histories of patients with homozygous mutations are worse than the other groups. Besides, chromosomal abnormalities and structural anomalies such as neural tube defects, cardiac anomalies and urinary system anomalies are found to be more frequent in patients with reduced MTHFR activity. We have also demonstrated that when patients are prepared and treated preconceptionaly the pregnancy outcomes are better. Low dose low molecular weight heparin together with low dose salisilic acid and vitamin B supplementations are effective in pregnancy outcomes in this group of patients. Conclusion: Patients with poor obstetrical history should be investigated in terms of the presence of MTHFR polymorphisms, so that necessary precautions can be taken preconceptionaly in order to prevent obstetrical/perinatal complications.

Journal of Bangladesh College of Physicians and Surgeons, 2014

Fibroids, the commonest benign pelvic tumor, have a common association with subfertility and increasing maternal age. Placenta praevia and fibroid (if submucous) has an association with placenta accreta. Here we report the case of an elderly primigravida with history of prolong subfertility, admitted with 37 weeks pregnancy with multiple fibroids and central placenta praevia with focal increta. Even with all these complicating factors, with the advent of better uterotonic drugs, conservative management could be considered successfully now-a-days.

Turkiye Klinikleri Journal of Case Reports, 2016

Ginekologia Polska

Pre-eklampsi; feto-plasental üniteyi ve anneyi etkileyen, 20. gebelik haftasından sonra gebelerin %3-5'ni komplike eden, hipertansiyon ve proteinüri ile seyreden bir durumdur. Pre-eklampsi fetüs ve anne için önemli risklerle ili kili olup; fetüste intrauterin geli me gerili i, ölüm ve prematüriteye, anne de ise endotelyal hasara ba lı eklampsi, renal yetmezlik, pulmoner ödem, inme ve de ölüme sebep olabilmektedir. Pre-eklampsinin patofizyolojisi, her a aması birbirini do uran, henüz tam çözülememi üç a amalı bir problem olarak dü ünülür. Birinci a amada meydana gelen düzensiz bir trofoblast i galinin durumu ba latan merkezi etmen oldu u dü ünülmektedir. kinci a amada plasenta hipoperfüzyonunu olu ur. Son a amada ise yaygın bir endotelyal hasarın meydana gelmesi ile patofizyolojik de i iklikleri olu turan unsurda olu mu olur. lk trimesterde artmı uterin arter Doppler PI ve RI de erleri, dü ük PAPP-A, HCG seviyeleri ve de iskemide modifiye olan albumin (IMA) pre-eklampsi etyolojisinde etkin olabilir.

Indian Journal of Obstetrics and Gynecology Research

Introduction: Placenta previa is a major cause of antepartum hemorrhage, leading to substantial fetomaternal morbidity and mortality. The aim of the present study was to determine the effect of placenta previa (PP) on pregnancy outcome. Material and Methods: It was a prospective study conducted over a period of 3 years including 262 antenatal women with PP at > 28 weeks of gestation. Results: In the present study 0.8% of the pregnant women were associated with placenta previa among them most of them were between 20-30 years (51.1%) and multigravida (90.0 %). Majority presented with bleeding between 30-34 weeks (46.9%).Most of the cases (80.2%) had one or the other known risk factors. Ultrasound was done in only 50.8% of cases, among which low lying placenta constituted major proportion(56.4%). 43.4% of women were kept on expectant management as they presented with bleeding at < 34 weeks of gestation. Only 14.5% of women had normal delivery, rest 85.5% underwent caesarean section. Adverse maternal outcome were seen in 40.8% of cases, out of which hemorrhagic shock (25.6%), postpartum hemorrhage (29.8%), Acute renal injury (4.58%), peripartum hysterectomy (9.16%). Most of the women (54.3%) needed >1 unit of blood transfusion. There were 9 cases of maternal mortality. Conclusion: Pregnancy complicated with PP poses a great challenge to every obstetrician due to associated fetomaternal complications. Early diagnonsis and timely intervention may improve outcome.

Journal of The Turkish German Gynecological Association, 2010

Classically, most women who develop preeclampsia (hypertension and proteinuria) present some time after 20 weeks of gestation up to 48 h postpartum;and this is especially true in otherwise healthy, nulliparous pregnancies. Recent data suggest that in some women, preeclampsia and even eclampsia may develop in the absence of hypertension or proteinuria. Here, we report four atypical cases: eclampsia in the absence of hypertension and proteinuria (case 1), a partial seizure following eclampsia with antecedent proteinuria, but no hypertension (case 2), a case presenting with fetal distress, but no hypertension (case 3), and a case with unusually rapid progression and massive proteinuria that was unresponsive to therapy (case 4). Problems with atypical forms of eclampsia lie in its unpredictable onset; timely diagnosis and management are critical in avoiding complications. The purpose of this review is to increase the awareness of atypical forms of hypertensive disorders during pregnancy. (J Turkish-German Gynecol Assoc 2010; 11: 115-7)