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Early second trimester incomplete abortion with undiagnosed placenta accreta encountered as an acute gynecological emergency: a case report


International Journal of Pregnancy & Child Birth
Sabre Alexander,  Rashid Waqarun, Arul Manonmani, Gaither Kecia, Jones Chandra

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Abstract

Placenta  accreta  spectrum  (PAS)  are  life-threatening  obstetrical  conditions,  which  may  have catastrophic outcomes when encountered in the emergency setting. We present a case of  a  36  yo  G4P3003  at  14  weeks  4  days  who  received  prenatal  care  at  outside  facility who had passage of incomplete abortion at home and brought in hypotensive shock with active vaginal bleeding. Massive transfusion protocol was started and patient was brought to operating room and proceeded with suction dilation and curettage. Despite removal of products of conception confirmed with US guidance; brisk heavy bleeding continued with use of multiple uterotonics. The decision was made to proceed with abdominal hysterectomy with removal of an atonic uterus that was bivalved in OR showing abnormal placentation later  confirmed  with  pathology.  Patient  postoperative  course  was  uneventful;  extubated from  surgical  ICU  and  discharged  3  days  later.  We  wish  to  highlight  the  importance  of astute clinical practice and timely decision making by the Ob/Gyn team in the presentation of a critical patient with placenta accreta encountered in the early second trimester.

Keywords

placenta accreta, abortion, vaginal bleeding, dilatation, hysterectomy, pregnancy

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