Successful Mx of placenta previa and placenta accreta
The present case has been published in the International Journal of Reproduction, Contraception, Obstetrics and Gynecology.

A 39-year-old female with gravida 2 and para 1 presented with lower abdominal pain at 32+2 weeks of pregnancy. She had a history of prior lower segment cesarean section three years earlier. A diagnosis of total placenta previa was made following examination on admission. She was advised complete bed rest and oral magnesium sulphate.

Abdominal ultrasonography (USG) showed an intact singleton pregnancy appropriately developed for age. Cervical length on vaginal sonography was 35 mm without funnelling. The placenta covered the inner os. Ultrasonography (USG) raised the suspicion of placenta accreta. Magnetic resonance imaging (MRI) was advised however, she complained of massive bleeding per vaginum and was rushed to the emergency. Her blood pressure was 70/50 mm of Hg and pulse rate of 126/ minute. The fetal heart rate was 226/ minute. Her haemoglobin was 6.4 gm%.

The patient was resuscitated with Ringer’s Lactate solution. An emergency cesarean section was planned. Intraoperatively engorged veins were seen over the lower uterine segment and bladder. The entire lower anterior uterine wall consisted only of a thin translucent layer of peritoneum with the placenta clearly visible through it. These clinical findings led to a diagnosis of placenta accreta. The uterine incision was made in the lower part of the upper segment.

A healthy female baby weighing 1.7 kg was delivered. Intravenous methylergonovine maleate was administered and the uterus started contracting. However profuse bleeding started from the partially separated placenta and her blood pressure dropped down to 60/40 mm of Hg. Placental bed was compressed with multiple wet mops.

Hysterectomy without adnexectomy was performed. The intraoperative blood loss was estimated to be 3.5 litres, which was simultaneously managed by transfusing 8 units of packed red cells concentrations, 8 units of fresh frozen plasma and 4 units of platelets intraoperatively.

The uterus with partially attached placenta was sent for histological examination.The uterus with partially attached placenta. Histopathological examination confirmed the diagnosis of total placenta previa with placenta accreta. She developed deep vein thrombosis on 4th post-operative day, which was managed by anticoagulants. She was discharged on 17th postoperative day.

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Dr. S●●●●●v S●●●●●1
Dr. S●●●●●v S●●●●●1 Obstetrics and Gynaecology
Till date there' s no consensus regarding number of layers uterine repair to be done nor the type of suture materials and with what force the sutures are to be tightened.Though several surgeons have been putting forth their isolated views no bigger and systematic sturdy has yet been done. But we, those have done hundreds of caesarean sections for last 3-4 decades are of strongest opinion that these types of outcomes i. e. presentations are the result of the type of work we have done in those patients in their previous births. Is it not the time to be careful ! Days are coming we would be solely responsible for this.... Read more
Oct 20, 2018Like1