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.


METHODS
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.


CONCLUSIONS
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.
Riggs
J C
JC
Department of Obstetrics and Gynecology, Wyckoff Heights Medical Center, Brooklyn, New York 11237, USA.
Jahshan
A
A
Schiavello
H J
HJ
D000328:Adult; D021721:Balloon Occlusion; D002404:Catheterization / Q000379:methods*; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D010921:Placenta Accreta / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D011247:Pregnancy; D014592:Uterine Hemorrhage / Q000209:etiology* / Q000601:surgery
D004791:Enzyme Inhibitors; D008727:Methotrexate