Conservative management of two cases of morbidly adherent placenta

It may be better to treat the cases of placenta percreta with conservative management, if the patients are hemodynamically stable and desirable for future fertility.

📌 3 Key Takeaways

🎯

Objective & Hypothesis:To present two cases of placenta percreta which were treated with conservative management in our clinic.

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Key Findings & Data:Two cases of retained placenta percreta are presented.

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Conclusion & Impact:It may be better to treat the cases of placenta percreta with conservative management, if the patients are hemodynamically stable and desirable for future fertility.

🔬Design:Olgu Sunumu

📍Scope:Comprehensive Sample

⚙️Variables:Placenta percreta · methotrexate · conservative

Abstract

To present two cases of placenta percreta which were treated with conservative management in our clinic. Two cases of retained placenta percreta are presented. Treatment was failed in the first case because of haemorrhage. The second one was treated successfully with the procedures which consisted of caesarean section with midline abdominal and classic incision in the uterine fundus, internal iliac artery ligation, prophylactic broad-spectrum antibiotic treatment, suppression of menstrual cycle, use of methotrexate until the achievement of rapid downtrend of human chorionic gonadotropin, and monitoring the patient until spontan expulsion or resorbtion of placenta. It may be better to treat the cases of placenta percreta with conservative management, if the patients are hemodynamically stable and desirable for future fertility.

Özet

Plasenta perkratada konservatif tedavi uygulanan iki olgu sunuldu. Kliniğimizde plasenta perkrata tanısı konan iki olguya konservatif tedavi uygulandı. İlk olguda kanamadan dolayı tedavide istenilen başarı elde edilemedi. İkinci olguda; abdominal orta hat ve uterin fundusda klasik insizyon, internal iliak arter ligasyonu, profilaktik geniş spektrumlu antibiyotik kullanımı, menstruel siklus supresyonu, human koryonik gonadotropin seviyesinde hızlı düşüş trendi elde edene kadar metotreksat uygulaması ve plasental atılım gerçekleşene kadar hastanın haftalık izlemi ile başarılı bir sonuç elde edildi. Hemodinamik olarak stabil ve fertilite isteği olan plasenta perkrata olgularında konservatif yaklaşım daha uygun bir seçenek olabilir.

Keywords

Placenta percreta methotrexate conservative ligation

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Cite This Article

Hilali, N., Incebiyik, A., Camuzcuoglu, A., Vural, M., Kocarslan, S., Karakaş, E., Yuce, H. H., Camuzcuoglu, H. (2014). Conservative management of two cases of morbidly adherent placenta. Harran Üniversitesi Tıp Fakültesi Dergisi, Cilt: 11 Sayı: 3, 304–308. https://ajindex.com/articles/1081723

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References (20)

Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005;192(5):1458-61
Zepiridis L, Zafrakas M, Theodoridis TD, Assimakopoulos E, Tzevelekis P, Athanatos D, Bontis JN, Tarlatzis BC. Human placental lactogen and color Doppler in predicting expulsion of retained adherent placenta: a new clinical observation. Arch Gynecol Obstet 2009;280(6):1041-4. doi: 10.1007/s00404-009- 1045-9
Hicks CW, Rome ES. Menstrual manipulation: options for suppressing the cycle. Cleve Clin J Med. 2010;77(7):445-53. doi: 10.3949/ccjm.77a.09128
Clément D, Kayem G, Cabrol D. Conservative treatment of placenta percreta: a safe alternative. Eur J Obstet Gynecol Reprod Biol 2004;114(1):108-109
Camuzcuoglu H, Toy H, Vural M, Yildiz F, Aydin H. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy.J Obstet Gynaecol Res 2010;36(3):538-43. doi: 10.1111/j.1447-0756.2010.01198.x
Steins Bisschop CN, Schaap TP, Vogelvang TE, Scholten PC. Invasive placentation and uterus preserving treatment modalities: a systematic review. Arch Gynecol Obstet 2011;284(2):491-502. doi: 10.1007/s00404-011-1934-6
Masuzaki H, Miura K, Yoshiura K, Yamasaki K, Miura S, Yoshimura S, Nakayama D, Mapendano CK, Niikawa N, Ishimaru T. Placental mRNA in maternal plasma and its clinical application to the evaluation of placental status in a pregnant woman with placenta previa-percreta. Clin Chem 2005;51(5):923-5
Ferretti C, Bruni L, Dangles-Marie V, Pecking AP, Bellet D. Molecular circuits shared by placental and cancer cells, and their implications in the proliferative, invasive and migratory capacities of trophoblasts. Hum Reprod Update 2006;13(2):121-41
Tseng JJ, Hsu SL, Ho ES, Hsieh YT, Wen MC, Chou MM. Differential expression of angiopoietin-1, angiopoietin-2, and Tie receptors in placentas from pregnancies complicated by placenta accreta. Am J Obstet Gynecol 2006;194(2):564-71
Wehrum MJ, Buhimschi IA, Salafia C, Thung S, Bahtiyar MO, Werner EF, Campbell KH, Laky C, Sfakianaki AK, Zhao G, Funai EF, Buhimschi CS. Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast. Am J Obstet Gynecol 2 0 1 1; 2 0 4 ( 5 ): 4 1 1. e 1 - 4 1 1. e 1 1. d o i: 10.1016/j.ajog.2010.12.027
Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005;192(5):1458-61
Zepiridis L, Zafrakas M, Theodoridis TD, Assimakopoulos E, Tzevelekis P, Athanatos D, Bontis JN, Tarlatzis BC. Human placental lactogen and color Doppler in predicting expulsion of retained adherent placenta: a new clinical observation. Arch Gynecol Obstet 2009;280(6):1041-4. doi: 10.1007/s00404-009- 1045-9
Hicks CW, Rome ES. Menstrual manipulation: options for suppressing the cycle. Cleve Clin J Med. 2010;77(7):445-53. doi: 10.3949/ccjm.77a.09128
Clément D, Kayem G, Cabrol D. Conservative treatment of placenta percreta: a safe alternative. Eur J Obstet Gynecol Reprod Biol 2004;114(1):108-109
Camuzcuoglu H, Toy H, Vural M, Yildiz F, Aydin H. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy.J Obstet Gynaecol Res 2010;36(3):538-43. doi: 10.1111/j.1447-0756.2010.01198.x
Steins Bisschop CN, Schaap TP, Vogelvang TE, Scholten PC. Invasive placentation and uterus preserving treatment modalities: a systematic review. Arch Gynecol Obstet 2011;284(2):491-502. doi: 10.1007/s00404-011-1934-6
Masuzaki H, Miura K, Yoshiura K, Yamasaki K, Miura S, Yoshimura S, Nakayama D, Mapendano CK, Niikawa N, Ishimaru T. Placental mRNA in maternal plasma and its clinical application to the evaluation of placental status in a pregnant woman with placenta previa-percreta. Clin Chem 2005;51(5):923-5
Ferretti C, Bruni L, Dangles-Marie V, Pecking AP, Bellet D. Molecular circuits shared by placental and cancer cells, and their implications in the proliferative, invasive and migratory capacities of trophoblasts. Hum Reprod Update 2006;13(2):121-41
Tseng JJ, Hsu SL, Ho ES, Hsieh YT, Wen MC, Chou MM. Differential expression of angiopoietin-1, angiopoietin-2, and Tie receptors in placentas from pregnancies complicated by placenta accreta. Am J Obstet Gynecol 2006;194(2):564-71
Wehrum MJ, Buhimschi IA, Salafia C, Thung S, Bahtiyar MO, Werner EF, Campbell KH, Laky C, Sfakianaki AK, Zhao G, Funai EF, Buhimschi CS. Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast. Am J Obstet Gynecol 2 0 1 1; 2 0 4 ( 5 ): 4 1 1. e 1 - 4 1 1. e 1 1. d o i: 10.1016/j.ajog.2010.12.027.