Laparoscopic Management of a Trapped Placenta Following Normal Delivery in a Woman With a Mullerian Anomaly

Entrapped placenta following vaginal delivery is an uncommon complication. In resistant cases, it needs to be removed by laparotomy, although this is exceptionally rare. Here, we report a 28-year-old woman, 33 weeks pregnant through in vitro fertilization, who delivered a premature male baby weighing 2400 grams with an Apgar score of 7. After delivery, the placenta remained in the unicornuate uterus. Ultrasound ruled out placenta accreta spectrum, and manual removal attempts under anesthesia failed due to lower uterine segment contraction despite using nitroglycerine. Conservative management with misoprostol and broad-spectrum antibiotics was initiated. However, increasing C-reactive protein levels and abdominal pain necessitated a computerized tomography scan, revealing the placenta trapped in the unicornuate uterus. Thirty-six hours after the delivery, the decision was made to remove the placenta laparoscopically instead of laparotomy. A unicornuate uterus containing a placenta on the right and the left rudimentary horn connected to the right uterus with bilateral adnexa, including theca cysts, were revealed during laparoscopic observation. No pelvic organ injury was noted. The placenta was removed via a fundal incision with a monopolar hook and using claw traumatic forceps. The uterus was closed with V-lock sutures; additional Z-sutures were applied. A 270-gram entire placenta was extracted using an endo bag successfully. The patient was discharged several days after the procedure without any complications. Laparoscopic extraction of a third-trimester placenta can successfully be used in resistant cases while avoiding laparotomy, even in the early postpartum period.