First-trimester abortion complicated with placenta accreta: A systematic review

Area of Science:

• Reproductive Medicine
• Gynecology
• Obstetrics

Background:

• Placenta accreta is a rare but severe complication of first-trimester abortion.
• Early recognition and management are crucial due to potential life-threatening outcomes.

Purpose of the Study:

• To review the literature on first-trimester postabortal placenta accreta.
• To identify risk factors, clinical presentations, and management strategies.

Main Methods:

• Systematic literature review of PubMed-indexed English journals up to August 2018.
• Inclusion of 19 articles and 23 case reports on first-trimester postabortal placenta accreta.

Main Results:

• Significant risk factors include previous cesarean section (87%), uterine curettage (43.5%), and advanced maternal age (≥35 years, 43.5%).
• Clinical presentation commonly involves vaginal bleeding with variable onset (immediate to delayed).
• Conservative management (e.g., UAE, TACE) may be attempted, but hysterectomy is often the definitive treatment.

Conclusions:

• A high index of clinical suspicion is essential for early diagnosis of postabortal placenta accreta.
• Prompt management improves outcomes for this emergent obstetric condition.