Conservative management of placenta increta after first trimester abortion by transcatheter arterial chemoembolization: a case report and review of the literature.
BACKGROUND
Placenta increta is a potentially life-threatening condition that may complicate a first trimester abortion in rare occasion. However, the therapeutic value of transcatheter arterial chemoembolization for the conservative management of this disorder is not described.


METHODS
A 27-year-old woman (gravida 3, para 1) with significant obstetric history for one previous lower segment cesarean section and one dilatation and curettage for missed abortion had uncomplicated dilatation and curettage for missed abortion. Eight weeks after curettage, the patient presented with increased amounts of vaginal bleeding. Image diagnostic modalities localized the heterogeneous mass within the myometrium in the fundal portion of the uterine corpus. Initially, arteriovenous fistula formation after abortion was suspected. However, an elevated serum hCG value indicated the presence of retained placental tissue and gave the diagnosis of persistent placenta increta after a first trimester abortion. Transcatheter arterial chemoembolization with dactinomycin was initiated to achieve immediate hemostasis and cytocidal effects on the placental tissue. The post-interventional course was uneventful. Twenty days after chemoembolization, the serum hCG value decreased to a normal level and the mass lesion disappeared on ultrasonography without secondary hemorrhagic complications.


CONCLUSIONS
After precise diagnostic imaging, transcatheter arterial chemoembolization is a useful minimally invasive procedure to achieve uterine preservation in women with placenta increta masquerading as arteriovenous fistula after a first trimester abortion.
Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, Gifu 507-8522, Japan. gyendoscopy@gmail.com
Akihiro
A
Takeda
Kazuyuki
K
Koyama
Sanae
S
Imoto
Masahiko
M
Mori
Tomoko
T
Nakano
Hiromi
H
Nakamura
D000030:Abortion, Missed / Q000601:surgery*; D000032:Abortion, Therapeutic / Q000009:adverse effects* / Q000379:methods; D000328:Adult; D000792:Angiography; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003609:Dactinomycin / Q000008:administration & dosage; D004107:Dilatation and Curettage / Q000009:adverse effects; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D010921:Placenta Accreta / Q000000981:diagnostic imaging / Q000628:therapy*; D011247:Pregnancy; D014463:Ultrasonography
D000903:Antibiotics, Antineoplastic; D003609:Dactinomycin