Naga Rachana Paidi, Chennuru Bharathna, Kathpalia Sukesh, Kshirsagar Shilpa
Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.
Cureus. 2024 Aug 18;16(8):e67147. doi: 10.7759/cureus.67147. eCollection 2024 Aug.
Adherent placenta means a placenta that is not delivered spontaneously or even after manual removal within 30 minutes of baby birth. It is an uncommon and frequently unanticipated event with serious potential health circumstances and it should be managed by the medical team. This case study presents a rare instance of placenta increta in a 25-year-old woman, second gravida, at 36 weeks of gestation, with a history of cesarean section 16 months prior due to chorioamnionitis. The patient presented to the labor room in active labor, and antenatal ultrasound indicated placental implantation on the posterior surface of the upper uterine segment. Given the short inter-delivery interval, an emergency preterm lower segment cesarean section (LSCS) was performed, resulting in the birth of a healthy baby girl weighing 1.8 kg. During surgery, a morbidly adherent placenta was found over the fundus of the uterus. Following consultations with the patient and her relatives, an emergency obstetric total hysterectomy was performed. Intraoperatively, the patient received one unit of packed cell volume (PCV) and, postoperatively, two additional units of PCV and two units of fresh frozen plasma (FFP) were administered. On the third postoperative day, the patient developed right lung consolidation, necessitating a five-day stay in the Obstetric Intensive Care Unit (OBICU). The remaining postoperative period was uneventful, and the patient was discharged on the 10th postoperative day with the healthy infant. Placenta accreta, including its variants increta and percreta, represents abnormal placental implantation into the uterine wall, a condition whose incidence is rising due to increased cesarean sections and improved imaging detection.
粘连性胎盘是指在胎儿出生后30分钟内不能自然娩出甚至人工剥离后仍未娩出的胎盘。这是一种罕见且常常难以预料的情况,具有严重的潜在健康风险,应由医疗团队进行处理。本病例研究呈现了一名25岁经产妇,妊娠36周时发生胎盘植入的罕见病例,该患者16个月前因绒毛膜羊膜炎行剖宫产术。患者进入产房时处于活跃期分娩,产前超声显示胎盘植入子宫上段后壁。鉴于两次分娩间隔时间短,遂行急诊早产低位剖宫产术,娩出一名体重1.8千克的健康女婴。手术过程中,发现子宫底部有一粘连严重的胎盘。与患者及其家属商议后,行急诊产科全子宫切除术。术中患者输注了1单位浓缩红细胞,术后又输注了2单位浓缩红细胞和2单位新鲜冰冻血浆。术后第3天,患者出现右肺实变,需在产科重症监护病房(OBICU)住院5天。术后其余时间病情平稳,患者于术后第10天与健康婴儿一同出院。胎盘植入,包括植入性胎盘和穿透性胎盘等变异类型,是指胎盘异常植入子宫壁,由于剖宫产率上升和影像学检测手段的改进,其发病率正在升高。