Placenta increta as an important cause of uterine mass after first-trimester Curettage (case report)

Authors

Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Placenta increta during the first trimester of pregnancy is very rare. This report describes two cases of placenta increta that caused prolonged vaginal bleeding after a first-trimester abortion. We were encountered two cases of placenta increta in October 2012 and May 2013. Case I: A 35-year-old patient with continues vaginal bleeding from 2 months after curettage due to missed abortion in the first trimester. The uterus was large, the human chorionic gonadotropin (BHCG) level was 112 mUI/mL and ultrasound showed an echogenic mass in the lower segment of the uterine cavity. She was a candidate for curettage but received hysterectomy because of massive vaginal bleeding. Pathology reported placenta increta. Case II: A 32-year-old patient in the 12th week of gestation with missed abortion. After 6 weeks from curettage, she returned with continues vaginal bleeding, BHCG = 55 mUI/mL and sonography showing mixed echo lesion in the uterine cavity like hydatiform mole. Total abdominal hysterectomy was performed. Pathology reported placenta increta. In patients with a history of recent first-trimester abortion presenting with prolonged vaginal bleeding, uterine mass and low-level BHCG, a diagnosis of abnormal placentaion should be kept in mind.

Keywords

1.
Read JA, Cotton DB, Miller FC. Placenta accreta: Changing clinical aspects and outcome. Obstet Gynecol 1980;56:31-4.  Back to cited text no. 1
    
2.
Resnik R, Lockwood CJ, Levine D, Barss VA. Management of Placenta Accreta, Incereta, and Percreta. 2013.  Back to cited text no. 2
    
3.
Chen CY, Wang KG. Late postpartum hemorrhage after homeostatic square suturing technique: A case report. J Reprod Med 2009;54:454-6.  Back to cited text no. 3
    
4.
Arredondo-Soberón F, Sabella V, Garza-Leal J, Valente PT. Placenta accreta during the first trimester of pregnancy.A case report. Ginecol Obstet Mex 1995;63:279-81.  Back to cited text no. 4
    
5.
Choi GD, Choi WK, Lee HS, Kim CB, Lee GN. A case of spontaneous rupture of the uterus with placenta increta in early pregnancy. Korean J Obstet Gynecol 1996;39:1359-64.  Back to cited text no. 5
    
6.
Komiya K, Saitou K, Inoue S, Igarashi T,Hirabayashi Y,Seo N. Massive hemorrhage associated with undiagnosed placenta percreta in a second-trimester pregnancy receiving abortion procedure. Masui 2009;58:1036-8.  Back to cited text no. 6
    
7.
Lee YT, Lee MH, Moon H, Hwang YY. A case of placenta increta which was found about 50 days after induced abortion at 1 st trimester. Korean J Obstet Gynecol 2000;43:1298-301.  Back to cited text no. 7
    
8.
Son G, Kwon J, Cho H, Kim S, Yoon B, Nam E, et al. A case of placenta increta presenting as delayed postabortal intraperitoneal bleeding in the first trimester. J Korean Med Sci 2007;22:932-5.  Back to cited text no. 8
    
9.
Ju W,Kim SC. Placenta increta after first-trimester dilatation and curettage manifesting as an unusual uterine mass: Magnetic resonance findings. Acta Radiol 2007;48:938-40.  Back to cited text no. 9
    
10.
Lim S,Ha SY,Lee KB,Lee JS. Retained placenta accretaafter a first-trimester abortion manifesting as an uterine mass. Obstet Gynecol Sci May 2013;56:205-7.  Back to cited text no. 10