title: The Feasibility of Conservative Management for Morbidly Adherent Placenta Accidentally Encountered after Vaginal Delivery.
abstract: OBJECTIVE
  To evaluate the feasibility of conservative management for patients with morbidly adherent placenta (MAP) accidentally encountered after term vaginal delivery.
  
  
  METHODS
  Medical records of patients with MAP who were accidentally encountered after term vaginal delivery and treated in our hospital from January 2009 to December 2015 were retrospectively reviewed.
  
  
  RESULTS
  A total of 8 eligible patients were included in this analysis. Primary postpartum hemorrhage occurred in 5 (62.5%) cases. Emergent uterine artery embolization, intrauterine balloon occlusion, and blood transfusion were performed in 5 (62.5%), 2 (25%), and 2 (25%) cases, respectively. Placentas were left in situ in all these 8 cases. Subsequent adjunctive medication treatments, including methotrexate, mifepristone, and traditional Chinese medicine, were administered in 7 (87.5%), 4 (50%), and 3 (37.5%) cases, respectively. The retained placenta spontaneously passed out in 4 (50%) patients. Additional curettage operation was performed in 3 (37.5%) patients. Emergent hysterectomy was performed in 1 (12.5%) patient due to cardiac insufficiency and acute pulmonary edema caused by sepsis. No other severe adverse events were identified.
  
  
  CONCLUSIONS
  Conservative management is feasible for patients with MAP accidentally encountered after vaginal delivery with close follow-up.
authors.affiliation: Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Ran
authors.initials: R
authors.lastname: Cui
authors.forename: Junli
authors.initials: J
authors.lastname: Lu
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Zhang
authors.forename: Huimin
authors.initials: H
authors.lastname: Bai
mesh_terms: D000019:Abortifacient Agents; D000328:Adult; D021721:Balloon Occlusion; D001803:Blood Transfusion; D000072700:Conservative Treatment / Q000379:methods*; D036861:Delivery, Obstetric; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008727:Methotrexate / Q000008:administration & dosage; D015735:Mifepristone / Q000008:administration & dosage; D010920:Placenta; D010921:Placenta Accreta / Q000175:diagnosis / Q000628:therapy*; D018457:Placenta, Retained; D006473:Postpartum Hemorrhage / Q000628:therapy; D011247:Pregnancy; D012189:Retrospective Studies; D055357:Uterine Artery Embolization; D014621:Vagina
chemical_list: D000019:Abortifacient Agents; D004365:Drugs, Chinese Herbal; D015735:Mifepristone; D008727:Methotrexate
keywords: Accidentally encountered after vagina delivery; Adjunctive medication treatments; Conservative management; Morbidly adherent placenta