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VOLUME 2 , ISSUE 2 ( April-June, 2018 ) > List of Articles


A Rare Case of Morbidly Adherent Placenta in a Primigravida

Hemlata Kuhite, Sharayu Mirji, Sangeeta Shingatgeri, Ganesh Shinde

Keywords : Adherent placenta, Conservative management, Primigravida, Uterine artery embolization

Citation Information : Kuhite H, Mirji S, Shingatgeri S, Shinde G. A Rare Case of Morbidly Adherent Placenta in a Primigravida. World J Anemia 2018; 2 (2):74-77.

DOI: 10.5005/jp-journals-10065-0036

License: CC BY-NC 4.0

Published Online: 01-09-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Aim: To report the occurrence of an adherent placenta in the absence of prior risk factors and discuss the various management options especially conservative management. Background: Morbidly adherent placenta (MAP) refers to any placental implantation with abnormally firm adherence to myometrium. Morbid adherence of placenta has evolved into one of the most serious problems in obstetrics. The incidence has increased tenfold in the past 50 years due to the increasing number of cesarean sections and has reached seemingly epidemic proportions. The American College of Obstetricians and Gynaecologists cites the incidence to be as high as 1 in 533 deliveries. Case report: We report a case of the placenta increta in a primigravida successfully managed by a conservative method with injection methotrexate followed by uterine artery embolization. Conclusion: Selected cases of the morbidly adherent placenta can be successfully managed conservatively. With proper selection of cases and adequate monitoring, modern conservative techniques have made preservation of fertility possible. Clinical significance: Only four cases of the adherent placenta in primigravida without any risk factors have been reported in the literature. Fertility preservation is a major concern in the management of these patients.

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  1. Wu S, Kocherginsky M, Hibbard JU. Abnormal placenta-: twenty-year analysis. Am J Obstet Gynecol 2005;192:1458-1461.
  2. ACOG committee opinion. Placenta accreta. Number 266, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 2002 Apr;77(1):77-78.
  3. Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancyrelated mortality in the United States, 1998 to 2005. Obstetrics and Gynecology 2010 Dec 1;116(6):1302-1309.
  4. Ansar A, Rauf N, Bano K, Liaquat N. Spontaneous rupture of primigravid uterus due to morbidly adherent placenta. J Coll Physicians Surg Pak 2009 Nov;19;732-733.
  5. Arnadottir BT, Hardardóttir H, Marvinsdóttir B. Case report seventeen year old primipara with placenta increta treated with methotrexate. Laeknabladid 2008;94(7-8):549-552.
  6. Kinoshita T, Ogawa K, Yasumizu T, Kato J. Spontaneous rupture of the uterus due to placenta percreta at 25-weeks of gestation: a case report. Journal of Obstetrics and Gynaecology Research 1996;22(2):125-128.
  7. Rajkumar B, Kumar N, Sowmya S. Placenta percreta in primigravida, an unsuspected situation. Int Jour of Reprod, Contracept, Obs & Gyn [Internet] 2014;3(1):239-241.
  8. Berkley EM, Abuhamad AZ. Prenatal Diagnosis of Placenta Accreta. Journal of Ultrasound in Medicine 2013;32(8):1345- 1350.
  9. Praevia P. Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management (Green-top Guideline No. 27). Royal College of Obstetricians and Gynaecologists. 2011.
  10. Rajkumar B, Kumar N, Srinivasan S. Placenta percreta in primigravida, an unsuspected situation Int J Reprod Contracept Obstet Gynecol 2014 Mar;3(1):239-241.
  11. Fox H. Placenta accreta 1945-1969. Obstet Gynecol Surv 1972; 27:475-479.
  12. Arulkumaran S, Ng CS, Ingemarsson I, Ratnam SS. Medical treatment of placenta accreta with methotrexate. Acta Obstet Gynecol Scand 1986;65:285-286.
  13. Kayem G, Davy C, Goffinet F, Thomas C, Clément D, Cabrol D. Conservative versus extirpative management in cases of placenta accreta. Obstet Gynecol 2004;104:531-536.
  14. Timor-Tritsch. Early placenta accreta and cesarean section scar pregnancy: a review. Am J Obstet Gynecol 2012.
  15. Tong SY, Tay KH, Kwek YC. Conservative management of placenta accreta: Review of three cases. Singapore Med J 2008;49:e156-159.
  16. Timmermans S, van Hof AC, Duvekot JJ. Conservative management of abnormally invasive placentation. Obstet Gynecol Survey 2007:62:529-539.
  17. Perez-Delboy A, Wright JD, Surgical management of placenta accrete: to leave or remove the placenta ? BJOG 2014;121: 163-170.
  18. Alanis M, Hurst BS, Marshburn PB, Matthews ML. Conservative management of placenta increta with selective arterial embolization preserves future fertility and results in a favorable outcome in subsequent pregnancies. Fertility and Sterility 2006 Nov 1;86(5):1514-e3.
  19. Chrisman HB, Saker MB, Ryu RK, Nemcek Jr AA, Gerbie MV, Milad MP, et al. The impact of uterine fibroid embolization on resumption of menses and ovarian function. Journal of Vascular and Interventional Radiology 2000 Jun 1;11(6): 699-703.
  20. Chauleur C, Fanget C, Tourne G, Levy R, Larchez C, Seffert P. Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases. Hum Reprod 2008;23:1553-1559.
  21. Descargues G, Mauger Tinlot F, Douvrin F, Clavier E, Lemoine JPL, Marpeau. Menses, fertility and pregnancy after arterial embolization for the control of postpartum haemorrhage Hum. Reprod 2004;19(2):339-343.
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