Department of Obstetrics & Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
J Med Case Rep. 2021 Sep 8;15(1):448. doi: 10.1186/s13256-021-03030-x.
Placenta accreta is known to be associated with significant maternal morbidity and mortality-primarily due to intractable bleeding during abortion or delivery at any level of gestation. The complications could be reduced if placenta accreta is suspected in a patient with a history of previous cesarean delivery and the gestational sac/placenta is located at the lower part of the uterus. Then, a proper management plan can be instituted, and complications can be reduced. The diagnosis of placenta accreta in the first trimester of pregnancy is considered uncommon.
A 34-year-old Malay, gravida 4, para 3, rhesus-negative woman was referred from a private hospital at 13 weeks owing to accreta suspicion for further management. She has a history of three previous lower-segment cesarean sections. She also had per vaginal bleeding in the early first trimester, which is considered to indicate threatened miscarriage. Transabdominal ultrasound revealed features consistent with placenta accreta spectrum. She was counseled for open laparotomy and hysterectomy because of potential major complication if she continued with the pregnancy. Histopathological examination revealed placenta increta.
A high index of suspicion of placenta previa accreta must be in practice in a patient with a history of previous cesarean deliveries and low-lying placenta upon ultrasound examination during early gestation.
胎盘植入已知与显著的产妇发病率和死亡率相关 - 主要是由于在任何妊娠水平的流产或分娩期间出现难以控制的出血。如果在有既往剖宫产史且妊娠囊/胎盘位于子宫下段的患者中怀疑存在胎盘植入，则可以减少并发症。然后，可以制定适当的管理计划，并减少并发症。在妊娠早期诊断胎盘植入被认为并不常见。
一名 34 岁的马来族妇女，第 4 次妊娠，第 3 次分娩，Rh 阴性，因疑似植入物而从私立医院转诊至我院，以进行进一步管理。她有三次既往下段剖宫产史。她还在孕早期出现过阴道出血，这被认为是先兆流产的迹象。经腹超声显示符合胎盘植入谱系的特征。由于如果继续妊娠可能会出现潜在的严重并发症，她被建议行剖腹手术和子宫切除术。组织病理学检查显示胎盘植入。
在有既往剖宫产史和超声检查在孕早期显示胎盘位置较低的患者中，必须高度怀疑胎盘前置植入。
