Perinatology.  2021 Jun;32(2):75-79. 10.14734/PN.2021.32.2.75.

Conservative Management of Retained Placenta Accreta Postpartum

• Joo EH
• Ko JE
• Lee Hl
• Kim HC
• Kim YR

• KMID: 2522519
• DOI: http://doi.org/10.14734/PN.2021.32.2.75

Abstract

Retained placenta accreta is difficult to diagnose in the series of processes involved in parturition. It is usually discovered after delivery, when massive and uncontrollable postpartum hemorrhage occurs. A histological examination of residual placental tissue is the gold standard for the diagnosis of retained placenta accreta and indicates the degree of placental invasion into the myometrium. If the placenta is forcefully removed, maternal morbidity and mortality is high. Therefore, the management is essential when the placenta cannot be delivered spontaneously or manually. We present a case of a 35-year-old woman (G4P2A1L2) who had a high risk of placenta accreta due to past history of placenta accreta and previous myomectomy. After successful delivery, the placenta was not delivered as expected. Consequently, she experienced massive post-partum hemorrhage of 1,500 mL for up to 2 days post-partum, necessary of an extensive blood transfusion. Following spontaneous vaginal delivery and a failed attempt to manually remove the placenta, a uterine artery embolization was performed, and the patient improved over a few weeks. Thus, this case was successfully managed with conservative treatment, avoiding hysterectomy or other additional surgical treatments. No secondary postpartum complications were observed, and the menstrual cycle returned to normal within 6 months.

Keyword

Placenta accrete; Postpartum hemorrhage; Conservative treatment; Uterine artery em bolization; Maternal mortality