Postpartum monitoring of retained placenta.Two cases of abnormally adherent placenta.
To save fertility, hysterectomy may be avoided with abnormal placental adherence by leaving the placenta in situ. Several reports support this strategy, but no reports are available on optimal follow-up strategies. We present two women with conservative treatment of placenta accreta and describe the prospective monitoring of the clinical course, placental regression, and recovery of the uterine anatomy using serial sonography, hysteroscopy and magnetic resonance imaging. There was no postpartum hemorrhage. Menstrual cyclicity resumed within 18 weeks. The human chorionic gonadotropin serum levels normalized within 10 weeks, whereas regression of placenta tissue was slow and continued up to nine months after delivery. In both cases placental remnants persisted; in one woman they were removed and uterine anatomy restored. She had a subsequent uneventful pregnancy afterwards. The presented systematic follow-up provides tools to monitor and treat other women in similar ways.
Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands. b.torrenga@vumc.nl
Bas
B
Torrenga
Judith A
JA
Huirne
Antoinette C
AC
Bolte
Jan Hein T M
JH
van Waesberghe
Johanna I P
JI
de Vries
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000328:Adult; D002585:Cesarean Section; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D010920:Placenta / Q000002:abnormalities* / Q000473:pathology*; D010921:Placenta Accreta / Q000097:blood / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome; D000267:Tissue Adhesions / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate