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Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion

BACKGROUND: The detection of a morbidly adherent placenta (MAP) in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal plac...

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Autores principales: Shah, Jaimin, Matta, Eduardo, Acosta, Fernando, Golardi, Natalia, Wallace-Huff, Cristina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664184/
https://www.ncbi.nlm.nih.gov/pubmed/29181211
http://dx.doi.org/10.1155/2017/6070732
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author Shah, Jaimin
Matta, Eduardo
Acosta, Fernando
Golardi, Natalia
Wallace-Huff, Cristina
author_facet Shah, Jaimin
Matta, Eduardo
Acosta, Fernando
Golardi, Natalia
Wallace-Huff, Cristina
author_sort Shah, Jaimin
collection PubMed
description BACKGROUND: The detection of a morbidly adherent placenta (MAP) in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal placental implantation. If these patients have a first trimester missed abortion and fail medical management, it is important that providers have a heightened suspicion for a MAP. CASE: A 24-year-old G4P3003 with 3 prior cesarean deliveries underwent multiple rounds of failed medical management for a missed abortion. She had a dilation and curettage that was complicated by a significant hemorrhage and ultimately required an urgent hysterectomy. CONCLUSION: When patients fail medical management for a missed abortion, providers need to assess the patient's risk factors for a MAP. If risk factors are present, a series of specific evaluations should be triggered to rule out a MAP and help further guide management. Early diagnosis of a MAP allows providers to coordinate a multidisciplinary treatment approach and thoroughly counsel patients. Ensuring adequate resources and personnel at a tertiary hospital is essential to provide the highest quality of care and improve outcomes.
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spelling pubmed-56641842017-11-27 Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion Shah, Jaimin Matta, Eduardo Acosta, Fernando Golardi, Natalia Wallace-Huff, Cristina Case Rep Obstet Gynecol Case Report BACKGROUND: The detection of a morbidly adherent placenta (MAP) in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal placental implantation. If these patients have a first trimester missed abortion and fail medical management, it is important that providers have a heightened suspicion for a MAP. CASE: A 24-year-old G4P3003 with 3 prior cesarean deliveries underwent multiple rounds of failed medical management for a missed abortion. She had a dilation and curettage that was complicated by a significant hemorrhage and ultimately required an urgent hysterectomy. CONCLUSION: When patients fail medical management for a missed abortion, providers need to assess the patient's risk factors for a MAP. If risk factors are present, a series of specific evaluations should be triggered to rule out a MAP and help further guide management. Early diagnosis of a MAP allows providers to coordinate a multidisciplinary treatment approach and thoroughly counsel patients. Ensuring adequate resources and personnel at a tertiary hospital is essential to provide the highest quality of care and improve outcomes. Hindawi 2017 2017-10-18 /pmc/articles/PMC5664184/ /pubmed/29181211 http://dx.doi.org/10.1155/2017/6070732 Text en Copyright © 2017 Jaimin Shah et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Shah, Jaimin
Matta, Eduardo
Acosta, Fernando
Golardi, Natalia
Wallace-Huff, Cristina
Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion
title Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion
title_full Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion
title_fullStr Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion
title_full_unstemmed Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion
title_short Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion
title_sort placenta percreta in first trimester after multiple rounds of failed medical management for a missed abortion
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664184/
https://www.ncbi.nlm.nih.gov/pubmed/29181211
http://dx.doi.org/10.1155/2017/6070732
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