![]() The estimated blood loss for the delivery was 400mL.Ībnormally invasive placenta is a potentially life-threatening complication of pregnancy, for which high index of suspicion should be held, even in cases with normal antepartum imaging. Her labor progressed normally and she delivered a female infant weighing 2940 grams with excellent Apgar scores of 9 and 10, at 1 and 5 minutes, respectively. Her antepartum US demonstrated a normal anterior placenta without any evidence of previa or invasion (Figure 1). However, without any intervention for her Ahserman’s syndrome, she was able to conceive spontaneously approximately 2 years after the birth of her first child. A year after the birth of her child, she had difficulty conceiving and was diagnosed with Asherman’s syndrome. Her obstetrical history was significant for two prior spontaneous abortions and a normal spontaneous vaginal delivery which was complicated by retained placenta (without an invasive component) for which she underwent a D&C. Herein, we present a case of retained invasive placenta that was undetected antenatally and in the immediate postpartum course that ultimately resulted in hysterectomy.Ī 37-year-old gravida 4 para 1 woman with a history of factor XI deficiency presented at 39 weeks gestation in spontaneous labor. Similarly, failure to diagnose RPOC can cause persistent primary and secondary PPH. ![]() Failure to detect invasive placenta can lead to life-threatening bleeding, with an estimated maternal mortality of 6%-7%. Magnetic resonance imaging (MRI) can be an useful adjunct to US to outline the extent of placental invasion or make the diagnosis when US is inclusive. Ultrasound (US) is the leading imaging modality for diagnosing both invasive placenta antenatally and suspected RPOC postnatally. While both invasive placenta and RPOC commonly cause postpartum bleeding, RPOC is typically managed by manual extraction or D&C, and invasive placenta is treated through conservative management or hysterectomy. RPOC is the incomplete expulsion of placenta or trophoblastic tissue after birth, with an incidence of 3%-5% after routine vaginal delivery. Trauma to the endometrium from prior uterine interventions such as dilatation and curettage (D&C), cesarean delivery, or myomectomy may result in Asherman’s syndrome, a condition which produces partial or complete obliteration of the uterine cavity and/or cervical canal and may result in menstrual abnormalities, dysmenorrhea, infertility, recurrent pregnancy loss, and postpartum hemorrhage. Its incidence has increased to deliveries over the past decade, and is strongly associated with placenta previa and prior uterine surgeries. Invasive placenta is the invasion of chorionic villi across the confinement of decidua basalis, and the adherence of the placenta on to the uterine myometrium. Retained products of conception, Invasive placenta, Postpartum hemorrhage, Vaginal bleeding, Hysterectomy, Asherman’s syndromeĪbnormal placentation and retention of products of conception (RPOC) are two common etiologies of postpartum hemorrhage (PPH). Results: Gross and histologic evaluation of the uterus demonstrated retained placenta accreta.Ĭonclusions: Our case highlights that while rare, retained invasive placenta can present as a cause of secondary PPH, particularly in patients with Asherman’s syndrome. ![]() ![]() During her hospital evaluation, she continued to bleed and ultimately underwent a total abdominal hysterectomy. Ultrasound and magnetic resonance imaging demonstrated an endometrial mass with vascularity. Two weeks following delivery, she returned to the hospital with persistent vaginal bleeding. Following normal vaginal delivery, portions of the placenta were retained and had to be manually extracted. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.īackground: Abnormal placentation and retention of products of conception (RPOC) are common causes of postpartum hemorrhage.Ĭase: A 37-year-old gravida 4 para 1 woman with history of Asherman’s syndrome from prior dilatation and curettage presented in spontaneous labor. Received: Ap| Accepted: Ap| Published: May 02, 2015Ĭitation: Koethe Y, Rizzuto GA, Kohi MP (2015) Retained Placenta Accreta Presenting as Secondary Postpartum Hemorrhage. Kohi, Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave., M-361, San Francisco, CA 94143, USA, Tel: 41, Fax: 41, E-mail: Gynecol Cases Rev, OGCR-2-035, (Volume 2, Issue 3), Case Report ISSN: 2377-9004 ![]()
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