Early Gestational Age Placenta Accreta Case Report: Can We Avoid Missed Diagnosis?
Sigit PurbadiHartono TjahjadiGatot PurwotoFitriyadi KusumaHariyono WinartoTofan Widya UtamiJunita IndartiGilbert Elia SotardugaPublished in: The American journal of case reports (2021)
BACKGROUND Placenta accreta is an abnormal invasive placenta that can be life-threatening because of the risk of hemorrhage. Its incidence has increased due to high cesarean delivery rates. Early gestational age placenta accreta is difficult to diagnose and misdiagnosis can lead to inappropriate treatment. CASE REPORT Patient 1, a 34-year-old woman (para 2 abortus 1) with 2 previous cesarean deliveries, was referred to our department for vaginal bleeding and abdominal pain. She received 2 curettages for blighted ovum; then, ultrasound examination found uterus perforation and fluid in the Douglas cavity. Exploratory laparotomy confirmed uterine perforation, and a hysterectomy was performed. Histopathological examination revealed placenta accreta. Patient 2, a 35-year-old woman (para 3) with 3 previous cesarean deliveries, was treated at a previous hospital for vaginal bleeding and stomach enlargement. She received serial chemotherapy for gestational trophoblastic neoplasia. Ultrasound examination showed a nonhomogeneous opacity in the lower uterine corpus with color score 4. Total abdominal hysterectomy was performed, and histopathological examination revealed placenta accreta. Patient 3, a 32-year-old woman (para 2) with 2 previous cesarean deliveries, had irregular vaginal bleeding suspected as gestational trophoblastic neoplasia due to ultrasound examination and positive beta-human chorionic gonadotropin. Ultrasound and MRI examination showed enlargement with nonhomogeneous opacity, color score 4, and bridging vessels. Due to our previous experience, we suspected it was a placenta accreta and performed a hysterectomy. The histopathology result indicated placenta accreta. CONCLUSIONS The key point in diagnosing placenta accreta properly is to evaluate the morphometric changes based on the structure using imaging like ultrasound. Collection and analysis of these data enables precise diagnosis in early gestational age placenta accreta.
Keyphrases
- gestational age
- case report
- birth weight
- magnetic resonance imaging
- preterm birth
- weight gain
- atrial fibrillation
- pregnant women
- ultrasound guided
- pulmonary embolism
- squamous cell carcinoma
- endothelial cells
- single cell
- computed tomography
- contrast enhanced
- body mass index
- physical activity
- electronic health record
- photodynamic therapy
- tertiary care
- weight loss
- smoking cessation
- fluorescence imaging