Placenta accreta: исходы оставления плаценты in situ

Abstract

This article presents a clinical case of a primigravida patient with undiagnosed placenta acrreta during pregnancy and cesarean delivery, in whom part of the placenta was left in situ. During 8 months postpartum, there were no specific complaints while breastfeeding, only an episode of scanty vaginal bleeding was noted. Ultrasound examination of the uterus revealed a clinical picture difficult to interpret. A hysteroscopy (hysteroresectoscopy) was performed, during which placental invasion was diagnosed, including into the scar after cesarean section. The placental tissue had a loose, vascular-free structure and a yellow, pale-yellow color. After excision of pathological tissue, it was found that the underlying myometrium had an identical structure and color. Pathoanatomical report: structureless zones with areas of granulation and connective tissue and numerous calcifications were determined in the muscle tissue. Conclusion. Leaving the placenta in situ in placenta acrreta results in gross changes in the myometrium, which can subsequently cause both infertility and pregnancy loss, as well as spontaneous uterine rupture during pregnancy. Key words: placenta acrreta, leaving the placenta in situ, operative hysteroscopy