Expectant management of placenta accreta after a mid-trimester pregnancy loss: a case report and a short review

Diletta Fumagalli,Tommaso Bignardi,Angelo Vanzulli,Paola Francesca Corbella,Mario Giuseppe Meroni,Maria Lieta Interdonato

doi:10.1515/crpm-2021-0008

Abstract

Abstract Objectives Placenta accreta spectrum (PAS) disorders are a significant cause of maternal morbidity and mortality. Traditionally women with PAS are offered surgery, while expectant management is still considered investigational. Case presentation We present a case of expectant management of PAS after pregnancy loss at 19-weeks. PAS was suspected at sonography and confirmed by MRI. Patient was offered expectant management to preserve fertility. This consisted of leaving the placenta in situ, followed by in- and out-patient clinical and sonographic examinations and blood tests. After five weeks placental detachment occurred without major complications. Conclusions Our report suggests that expectant management could be a safe option in selected cases of PAS after mid-trimester pregnancy loss. We recommend expectant management should be offered in referral centers for PAS.

Highlights

Placenta accreta spectrum (PAS) disorders have been increasingly reported in the last four decades
In case of clinical stability, these women could be offered a strict and cautious follow-up as outpatients, but they should be referred to a tertiary center if any complication arise, because they may need advanced hemostatic techniques (i.e., uterine arteries embolization (UAE)) or complex surgery by a gynecology oncologist
Placenta accreta is defined as abnormal trophoblast invasion of part or all the placenta into the myometrium of the uterine wall

Summary

Introduction

Placenta accreta spectrum (PAS) disorders have been increasingly reported in the last four decades. The woman was brought by ambulance to a primary care hospital about 30 min after delivery. She was diagnosed with placental retention, and PAS was suspected after an attempt of manual evacuation failed. Vital signs were normal on arrival and during the attempt of manual evacuation; the estimated blood loss was 200 mL. Patient’s medical history was significant for obesity (BMI 31 kg/m2), a previous laparotomic myomectomy for multiple uterine fibroids, and a recent diagnosis of recurrent multiple uterine fibroids. She had conceived through intracytoplasmic sperm injection (ICSI)

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Conclusion