AJP Rep 2015; 05(01): e6-e11
DOI: 10.1055/s-0034-1395992
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Case Report and Literature Review of Midtrimester Termination of Pregnancy Complicated by Placenta Previa and Placenta Accreta

Satoko Matsuzaki
1  Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
,
Shinya Matsuzaki
1  Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
,
Yutaka Ueda
1  Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
,
Yusuke Tanaka
1  Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
,
Mamoru Kakuda
1  Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
,
Takeshi Kanagawa
1  Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
,
Tadashi Kimura
1  Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
› Author Affiliations
Further Information

Publication History

02 August 2014

11 September 2014

Publication Date:
18 December 2014 (eFirst)

  

Abstract

Objective Concurrent placenta previa and placenta accreta increase the risk of massive obstetric hemorrhage. Despite extensive research on the management of placenta previa (including placenta accreta, increta, and percreta), the number and quality of previous studies are limited. We present a case of placenta accreta requiring an induced second-trimester abortion because of premature rupture of the membranes (PROM).

Study Design Case report and review of the literature.

Results A 41-year-old female presented at 20 weeks of gestation with placenta previa and PROM. Ultrasonography revealed placenta accreta with multiple placental lacunae. She then developed massive hemorrhaging just prior to a planned termination of pregnancy. We performed a hysterectomy with the intent of preserving life because of the failure of the placenta to detach and blood loss totaling 4,500 mL.

Conclusion Previous studies suggest that second-trimester pregnancy terminations in cases of placenta previa which are not complicated with placenta accreta do not have a particularly high risk of hemorrhage. However, together with our case, the literature suggests that placenta previa complicated with placenta accreta presents a significant risk of hemorrhage both during delivery and intraoperatively. Further reports are needed to evaluate the most appropriate treatment options.