Kassas Juliette M, Blue Lauren M, Brenner Carol A
Osteopathic Medicine, University of New England, Biddeford, USA.
Obstetrics and Gynecology, Speare Memorial Hospital, Plymouth, USA.
Cureus. 2021 Sep 17;13(9):e18042. doi: 10.7759/cureus.18042. eCollection 2021 Sep.
A 32-year-old female with unexplained infertility delivered a healthy male infant at 39 weeks 0 days gestational age; the pregnancy was facilitated by in vitro fertilization. Shortly after delivery, she was found to have a morbidly adherent placenta. Attempted removal resulted in postpartum hemorrhage and ultimately hysterectomy after attempting multiple fertility preserving methods to achieve hemostatic control. Pathology results revealed a diagnosis of a 0.1 cm placenta increta (Grade 2 placental villi invasion), the least common diagnosis within the placenta accreta spectrum (PAS). Likely due to the small point of trophoblastic invasion, the diagnosis and outcome were not foreseen. This case highlights the need for additional data collection and development of standardized guidelines for the diagnosis and management of PAS, given a patient's risk factors. Current research may be limited by stigmatization surrounding infertility and reproductive-altering surgeries (e.g. hysterectomy). Additionally, counseling in all stages of pregnancy is critical to achieving the best patient-centered outcomes.
一名32岁不明原因不孕症女性在孕39周0天时通过体外受精产下一名健康男婴。分娩后不久，她被发现患有胎盘植入异常。试图切除导致产后出血，在尝试多种保留生育功能的方法以实现止血控制后最终进行了子宫切除术。病理结果显示诊断为0.1厘米的胎盘植入（2级胎盘绒毛侵入），这是胎盘植入谱系（PAS）中最不常见的诊断。可能由于滋养层侵入点较小，诊断和结果未能预见。鉴于患者的风险因素，该病例凸显了收集更多数据以及制定PAS诊断和管理标准化指南的必要性。目前的研究可能受到围绕不孕症和改变生殖的手术（如子宫切除术）的污名化影响。此外，孕期各阶段的咨询对于实现以患者为中心的最佳结果至关重要。
