Surgical Interventions for Interstitial Pregnancy in the Third Trimester with Placenta Accreta

Abstract

Background: The clinical features of interstitial pregnancy in the third trimester with placenta accreta are not well documented, and there are no management guidelines to recommend for these patients. Most such cases in the literature reports received complete or subtotal hysterectomy for placenta accreta or uncontrolled postpartum hemorrhage. Methods: We performed a retrospective review of the medical records of patients with interstitial pregnancies in the third trimester with placenta accreta who were admitted to our obstetrical department as normal intrauterine pregnancies. The diagnostic evidence was based on the definition of the condition in combination with intraoperative surgical findings. Surgical interventions were performed on the patients to control postpartum hemorrhage. Findings: Of 16063 patients, a total of 87 patients had an enlargement of uterine cornu in the third trimester with entire placenta accreta. Of 87 cases, 70 cases were excluded from this study, which including angular pregnancies, cornual pregnancies, cases without surgical photographs or the surgical photographs were indistinct, and vaginal deliveries. 17 cases of interstitial pregnancies in the third trimester with placenta accreta were identified based on the combination of the definition and surgical findings. Evidence of the extremely bulged cornu, an empty uterine cavity, an absence of myometrium in the cornual-fundus and placenta accreta was found in all patients. Same surgical interventions were performed on them to manage placenta accreta and control postpartum hemorrhage. All patients kept their uteruses intact through surgical interventions without further traumatic interventions. Most of them had a spontaneous recurrence of menstruation. Interpretation: A bulged cornu, empty uterine cavity, placenta accreta and absence of cornual myometrium were the main characteristics of interstitial pregnancies in the third trimester with placenta accreta. Such patients can preserve their uterus through suitable surgical interventions. Funding Statement: The authors state: There was no funding for this study. Declaration of Interests: The authors state: None reported. Ethics Approval Statement: The study was designed by the first author and was approved by the Review Committee of the hospital. The first author vouches for the truthfulness and accuracy of the data. All patients provided written informed consent.