Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia.
Department of Pathology and Anatomy, University of Indonesia Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia.
Am J Case Rep. 2021 Nov 1;22:e934168. doi: 10.12659/AJCR.934168.
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.
胎盘植入是一种异常的胎盘侵入性疾病，由于出血风险，可能危及生命。由于剖宫产率高，其发病率有所增加。早期妊娠胎盘植入难以诊断，误诊可能导致不当治疗。
患者 1，34 岁女性（流产 2 次，足月产 1 次），有 2 次剖宫产史，因阴道出血和腹痛就诊。她因胚胎停育接受了 2 次刮宫术；随后，超声检查发现子宫穿孔和道格拉斯腔积液。剖腹探查术证实子宫穿孔，并进行了子宫切除术。组织病理学检查显示胎盘植入。患者 2，35 岁女性（流产 3 次，足月产 1 次），因阴道出血和腹部增大在之前的医院接受治疗。她因妊娠滋养细胞肿瘤接受了连续化疗。超声检查显示子宫下段不均匀混浊，彩色评分 4 分。行全子宫切除术，组织病理学检查显示胎盘植入。患者 3，32 岁女性（流产 2 次，足月产 1 次），因超声检查和β-人绒毛膜促性腺激素阳性，被怀疑患有妊娠滋养细胞肿瘤，出现不规则阴道出血。超声和 MRI 检查显示子宫增大，不均匀混浊，彩色评分 4 分，有桥接血管。鉴于我们之前的经验，我们怀疑这是胎盘植入，并进行了子宫切除术。组织病理学结果表明胎盘植入。
正确诊断胎盘植入的关键是使用超声等影像学方法评估结构的形态变化。收集和分析这些数据可实现早期妊娠胎盘植入的精确诊断。
