Here is an interesting case published in Journal of Minimally Invasive Gynecology of focal invasive placentation in 39 year old woman post laproscopic Myomectomy.
A 39-year-old woman underwent laparoscopic myomectomy for a 6cm posterior fundal leiomyoma . The uterine serosa was incised with monopolar electrosurgery and the myoma was enucleated using a laparoscopic corkscrew with blunt dissection. During this process, the endometrial cavity was entered. The endometrium was reapproximated with absorbable suture in a running fashion. The overlying myometrium was closed in three layers using barbed delayed absorbable suture in a running fashion. Surgery was otherwise uncomplicated. Sonohysterogram completed 3 months postoperatively found a normal cavity.
Spontaneous conception occurred six months postoperatively. Ultrasound at 20-weeks gestation documented normal fetal anatomy and a fundal placenta. The patient presented with acute abdominal pain at 31-weeks gestation. Ultrasound revealed possible placental invasion of the posterior uterine wall and MRI identified two areas of uterine dehiscence at the prior myomectomy site
Caesarean section was performed at 36-weeks gestation. The placenta was seen invading through a 5cm myometrial defect at the prior myomectomy site with no overlying residual myometrium. Following placental extraction, the defect was excised and healthy-appearing adjacent myometrium was reapproximated in three layers. Estimated blood loss was 1000 milliliters. Histopathology confirmed placenta accreta.
In summary, Laparoscopic myomectomy is often performed to preserve or enhance fertility. However, myomectomy may weaken the myometrium resulting in pregnancy complications. Case highlights a rare complication of myomectomy: placenta accreta spectrum (PAS) disorder. PAS most commonly occurs following prior caesarean delivery.
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