A RARE PLACENTAL ABNORMALITY IN PRIMIGRAVIDA

Dr. Ramalingam, Dr.G Sahika

Abstract


INTRODUCTION: Placenta increta is a component of placenta accrete spectrum. It is one of the leading causes of
emergency hysterectomy. The exact pathogenesis of the condition is unknown.
CASE SCENARIO: Primigravida with 28 weeks gestation referred to NRI hospital in view of preterm premature rupture
of membranes. After investigating, patient was induced and foetus was delivered but placenta was not expelled
spontaneously even after 2hrs. USG revealed placenta accreta. Cord knot was applied along with injection methotrexate
50mg IM was given for conservative management. There was fall in haemoglobin level with foul smelling vaginal
discharge associated with fever for which blood transfusions and higher antibiotics were started. Bilateral uterine artery
embolization was done, even then patient's condition deteriorated and was taken up for manual removal of placenta
under GA. As manual removal was not successful, hysterotomy was done and placenta was removed completely. As there
was minimal bleeding, hysterectomy was not done.
DISCUSSION: Placenta increta is extremely rareform in which there is penetration of villi into uterine musculature. In
accreta, placenta is directly anchored to myometrium and in percreta, placenta penetrate upto serosal layer.
CONCLUSION: Placenta increta is a rare condition to occur in non scared uterus. By proper investigations such as USG,
MRI; placental abnormalities can be ruled out in high risk patients.


Keywords


Placenta increta, Placenta accreta, Placenta accrete spectrum, Uterine artery embolization, Emergency hysterectomy.

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