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Placenta previa accreta with cervical involvement causing tenacious postpartum hemorrhage: a case report
1Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi = Chinese Medical Journal; Free China Ed
|April 9, 1998
Summary
Conservative treatment for placenta accreta can lead to severe postpartum hemorrhage. This case highlights the critical need for prompt hysterectomy in cases of cervical involvement to prevent maternal mortality.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Conservative management of placenta accreta is increasingly common.
- Placenta accreta, particularly with cervical involvement, poses a significant risk of postpartum hemorrhage and maternal death.
Observation:
- A gravida-2 para-1 patient with a history of cesarean section presented with placenta previa and placenta accreta.
- Following a repeat cesarean delivery, conservative measures for retained placental tissue failed to control tenacious postpartum hemorrhage.
Findings:
- Persistent vaginal bleeding despite initial conservative management (oxytocin, ergometrine, uterine packing) led to shock.
- Emergency laparotomy revealed active cervical bleeding, necessitating a total abdominal hysterectomy.
Implications:
- Cervical involvement in placenta accreta requires aggressive surgical management, including hysterectomy, to mitigate risks.
- Prompt hysterectomy is crucial in managing severe postpartum hemorrhage associated with cervical placenta accreta to reduce maternal morbidity and mortality.