1/81. Alternative conservative management of placenta accreta. A case report.BACKGROUND: placenta accreta is a rare event in pregnancy and may cause life-threatening hemorrhage. This obstetric complication is a diagnostic and management challenge. When the condition is diagnosed, medical management is usually employed first for hemostasis. If the bleeding cannot be controlled, conservative surgical management is attempted, but hysterectomy is often required for definitive care. CASE: The diagnosis of placenta accreta was made intraoperatively at cesarean section undertaken for breech presentation. The placenta was densely adherent to the anterior lower uterus. Severe hemorrhage, which resulted from attempts to manually remove it, was treated with oxytocin, carboprost tromethamine and methylergonovine without success. The uterus was everted to provide access to the placental site, which was excised; the myometrial defect was sutured closed. Three Foley balloons were used to provide uterine tamponade. methotrexate was administered prophylactically. These measures effectively controlled the hemorrhage. CONCLUSION: Because placenta accreta might not be diagnosed antepartum or during labor, especially when no risk factors are present, adequate preparations cannot be made. If it is diagnosed at the time of cesarean section, a combined conservative approach may prove helpful in controlling bleeding and avoid hysterectomy and hypovolemia.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/81. Identification of mtDNA mutation in a pedigree with gestational diabetes, deafness, wolff-parkinson-white syndrome and placenta accreta.Mitochondrial dna (mtDNA) defects are associated with a number of human disorders. Although many occur sporadically, maternal transmission is the hallmark of diseases due to mtDNA point mutations. The same mutation may manifest strikingly different phenotypes; for example, the A to G substitution at np 3243 was first reported in patients with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (the melas syndrome), but is also found in patients with diabetes and deafness. Here we present a case of gestational diabetes, deafness, premature greying, placenta accreta and Wolff-Parkinson-White (WPW) syndrome associated with a mtDNA mutation. Although this is the first report of such an association, study of 27 other patients with WPW syndrome failed to confirm that this mtDNA mutation is a common cause of such pre-excitation disorders.- - - - - - - - - - ranking = 6.3880465939823keywords = gestation (Clic here for more details about this article) |
3/81. Expectant management of placenta accreta following stillbirth at term: a case report.placenta accreta is a rare complication of pregnancy with high rates of morbidity and mortality. We report a case of expectant management. This strategy may prevent catastrophic postpartum haemorrhage requiring peripartum hysterectomy.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
4/81. placenta accreta associated with a ruptured pregnant rudimentary uterine horn. Case report and review of the literature.pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity and mortality. A case of pregnancy in a rudimentary uterine horn with rupture 14 weeks after last menstrual period and is complicated with placenta accreta is presented. The patient had signs and symptoms of massive hemoperitoneum. An emergency exploratory laparotomy revealed rupture of the gravid rudimentary horn of a bicornuate uterus. Histologic examination of the specimen showed that placenta was accreta. The relative literature is reviewed and the association of placenta accreta in such situations is pointed out.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
5/81. Placenta increta/percreta associated with uterine perforation during therapy for fetal death. A case report.BACKGROUND: placenta accreta involves abnormal adherence of the placenta to the myometrium. Placenta increta and percreta are defined by the degree of trophoblastic penetration of the myometrium. These conditions are rarely observed in the first trimester; placenta increta and percreta are exceptionally infrequent. CASE: A woman had a uterine perforation after suction curettage for fetal death at 11 weeks' gestation, requiring hysterectomy for control of a profuse hemorrhage. Histopathologic examination of the uterus revealed placenta increta involving the lower uterine segment and placenta percreta at the site of uterine perforation. CONCLUSION: This is the first report of placenta percreta associated with uterine perforation during therapy for first-trimester fetal death.- - - - - - - - - - ranking = 1.2776093187965keywords = gestation (Clic here for more details about this article) |
6/81. Placenta percreta and uterine rupture associated with prior whole body radiation therapy.BACKGROUND: Injury to reproductive organs including the uterus is a known complication of ionizing radiation, but the risks to the mother and fetus during subsequent pregnancies are not well defined. CASE: A young woman with a remote history of whole body irradiation for childhood leukemia had uterine rupture at 17 weeks' gestation. Pathologic examination of the supracervical hysterectomy specimen revealed a posterior-fundal placenta percreta with a diffusely thinned myometrium (1-6 mm). The clinicopathologic findings were consistent with prior radiation injury. CONCLUSION: Uterine irradiation may predispose to abnormal placentation and uterine rupture in a subsequent pregnancy.- - - - - - - - - - ranking = 2.2776093187965keywords = gestation, pregnancy (Clic here for more details about this article) |
7/81. Recurrent uterine rupture after abdominal pregnancy.uterine rupture can occur at any time throughout gestation. We present a woman with a previous cesarean section followed by an abdominal pregnancy. In her next pregnancy, complete uterine rupture resulted in an emergency laparotomy. This case is unique in that it gives insight into the variable presentations of uterine rupture and the risks associated with prior Cesarean sections.- - - - - - - - - - ranking = 7.2776093187965keywords = gestation, pregnancy (Clic here for more details about this article) |
8/81. placenta accreta diagnosed at 9 weeks' gestation.The majority of cases of placenta accreta are unanticipated and initially identified intraoperatively. Although color Doppler ultrasound is adequate for the evaluation of placenta accreta in the third trimester, ultrasound diagnosis in the first trimester has never been reported. To our knowledge, this is the first case of placenta accreta detected at 9 weeks' gestation by ultrasound. placenta accreta with intraplacental lacunae can be identified together with a loss of the hypoechogenic retroplacental myometrial zone. Based on this case, we found that early diagnosis of placenta accreta in the first trimester by ultrasound is possible.- - - - - - - - - - ranking = 6.3880465939823keywords = gestation (Clic here for more details about this article) |
9/81. Failure of methotrexate and internal iliac balloon catheterization to manage placenta percreta.BACKGROUND: Placenta percreta is a rare but potentially lethal condition. Previously described conservative measures to avoid life-threatening hemorrhage and preserve fertility include use of methotrexate and uterine artery embolization. CASE: A woman with suspected placenta percreta diagnosed on ultrasound in the second trimester was delivered by classic, fundal cesarean at 30 weeks' gestation for bleeding and premature rupture of membranes. The placenta was left in situ, and she was treated with methotrexate. Postpartum bleeding 1 week later was managed by internal iliac balloon catheterization and manual transcervical removal of the placenta, which resulted in hysterectomy and required massive blood transfusion. CONCLUSION: Placenta percreta managed conservatively with methotrexate and internal iliac balloon catheterization resulted in serious morbidity.- - - - - - - - - - ranking = 1.2776093187965keywords = gestation (Clic here for more details about this article) |
10/81. fertility after conservative treatment of placenta accreta.OBJECTIVE: To report a pregnancy with vaginal delivery after a preceding pregnancy complicated by placenta accreta that was managed conservatively.DESIGN: Case report.SETTING: University medical center.PATIENT(S): A patient with placenta accreta that was managed conservatively.INTERVENTION(S): The placenta was left in situ and both uterine arteries were embolized.MAIN OUTCOME MEASURE(S): Preservation of reproductive capacity.RESULT(S): The patient had a term pregnancy with uncomplicated vaginal delivery.CONCLUSION(S): pregnancy is possible after conservative treatment of placenta accreta. This treatment should be considered in the appropriate circumstances to preserve reproductive capacity.- - - - - - - - - - ranking = 3keywords = pregnancy (Clic here for more details about this article) |
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