Souayeh Nesrine, Smida Hana, Rouis Hadhami, Lika Amira, Mbarki Chaouki, Bettaieb Hajer
Department of Gynecology and Obstetrics, Ben Arous Regional Hospital, Ben Arous, Tunisia; Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia.
Department of Gynecology and Obstetrics, Ben Arous Regional Hospital, Ben Arous, Tunisia; Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia.
Int J Surg Case Rep. 2024 Sep;122:110172. doi: 10.1016/j.ijscr.2024.110172. Epub 2024 Aug 13.
Placenta accreta spectrum in the first trimester is a rare but life-threatening condition. Its diagnosis and management remain challenging due to the lack of diagnostic criteria and therapeutic guidelines. This case report emphasizes the importance of early diagnosis of first trimester placenta accreta to perform fertility-sparing management.
A 29-year-old gravida 2 para 1 woman, with history of cesarean delivery, presented with abnormal uterine bleeding. On physical examination, she had minimal vaginal bleeding with normal haemodynamic parameters. An endovaginal ultrasound revealed a non-viable fetus and a low implanted gestational sac. Cesarean scar pregnancy (CSP) was suspected. The patient underwent an ultrasound-guided uterine dilatation and curettage, complicated with massive bleeding. Before an emergency laparotomy was carried out, bleeding was controlled with a Foley catheter balloon. Conservative management was performed with bilateral hypogastric artery ligation followed by the placenta accreta niche resection. Pathology confirmed first-trimester placenta accreta.
Placenta accreta spectrum disorders can occur even in the first trimester. Traditionally, hysterectomy has been the treatment of choice, but conservative management is possible with careful case selection and monitoring. Careful preoperative planning, including multidisciplinary consultation, is key to improving maternal outcomes. Maintaining high index of suspicion for placenta accreta spectrum disorders, and early diagnosis through ultrasonography, is crucial in the first trimester to perform fertility-sparing surgical management.
Placenta accreta spectrum incidence is increasingly rising. First-trimester placenta accreta should be suspected in high-risk situations. Conservative management can be offered in selected cases.
孕早期胎盘植入谱系疾病是一种罕见但危及生命的病症。由于缺乏诊断标准和治疗指南，其诊断和管理仍然具有挑战性。本病例报告强调了孕早期胎盘植入早期诊断对于实施保留生育功能管理的重要性。
一名29岁、孕2产1的女性，有剖宫产史，因异常子宫出血就诊。体格检查时，她阴道少量出血，血流动力学参数正常。经阴道超声检查发现胎儿已无生命迹象，妊娠囊着床位置低。怀疑为剖宫产瘢痕妊娠（CSP）。患者接受了超声引导下的子宫扩张刮宫术，并发大出血。在进行急诊剖腹手术前，用Foley导尿管球囊控制出血。采取双侧髂内动脉结扎术，随后切除胎盘植入灶进行保守治疗。病理证实为孕早期胎盘植入。
胎盘植入谱系疾病甚至可发生在孕早期。传统上，子宫切除术一直是首选治疗方法，但经过仔细的病例选择和监测，保守治疗也是可行的。仔细的术前规划，包括多学科会诊，是改善孕产妇结局的关键。对胎盘植入谱系疾病保持高度怀疑指数，并通过超声检查进行早期诊断，对于孕早期实施保留生育功能的手术管理至关重要。
胎盘植入谱系疾病的发病率日益上升。在高危情况下应怀疑孕早期胎盘植入。在某些选定病例中可提供保守治疗。
