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
PDF Full Text
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.
placenta accreta, abortion, vaginal bleeding, dilatation, hysterectomy, pregnancy