A Case Report and Literature Review of Midtrimester Termination of Pregnancy Complicated by Placenta Previa and Placenta Accreta
02 August 2014
11 September 2014
18 December 2014 (online)
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.
- 1 Silver RM, Landon MB, Rouse DJ , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107 (6) 1226-1232
- 2 Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 2006; 107 (4) 927-941
- 3 Rao KP, Belogolovkin V, Yankowitz J, Spinnato II JA. Abnormal placentation: evidence-based diagnosis and management of placenta previa, placenta accreta, and vasa previa. Obstet Gynecol Surv 2012; 67 (8) 503-519
- 4 Robinson BK, Grobman WA. Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta. Obstet Gynecol 2010; 116 (4) 835-842
- 5 Matsuzaki S, Yoshino K, Kajimoto E , et al. Successful management of placenta percreta by cesarean hysterectomy with transverse uterine fundal incision. Int J Reprod Contracept Obstet Gynecol. 2014; 3 (2) 447-449
- 6 Belfort MA ; Publications Committee, Society for Maternal-Fetal Medicine. Placenta accreta. Am J Obstet Gynecol 2010; 203 (5) 430-439
- 7 Tuzovic L. Complete versus incomplete placenta previa and obstetric outcome. Int J Gynaecol Obstet 2006; 93 (2) 110-117
- 8 Yang JI, Lim YK, Kim HS, Chang KH, Lee JP, Ryu HS. Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior Cesarean section. Ultrasound Obstet Gynecol 2006; 28 (2) 178-182
- 9 Levine D, Hulka CA, Ludmir J, Li W, Edelman RR. Placenta accreta: evaluation with color Doppler US, power Doppler US, and MR imaging. Radiology 1997; 205 (3) 773-776
- 10 Comstock CH, Love Jr JJ, Bronsteen RA , et al. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Am J Obstet Gynecol 2004; 190 (4) 1135-1140
- 11 Lam G, Kuller J, McMahon M. Use of magnetic resonance imaging and ultrasound in the antenatal diagnosis of placenta accreta. J Soc Gynecol Investig 2002; 9 (1) 37-40
- 12 Warshak CR, Eskander R, Hull AD , et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 2006; 108 (3, Pt 1) 573-581
- 13 Thomas AG, Alvarez M, Friedman Jr F, Brodman ML, Kim J, Lockwood C. The effect of placenta previa on blood loss in second-trimester pregnancy termination. Obstet Gynecol 1994; 84 (1) 58-60
- 14 Rashbaum WK, Gates EJ, Jones J, Goldman B, Morris A, Lyman WD. Placenta accreta encountered during dilation and evacuation in the second trimester. Obstet Gynecol 1995; 85 (5, Pt 1) 701-703
- 15 Borgatta L, Chen AY, Reid SK, Stubblefield PG, Christensen DD, Rashbaum WK. Pelvic embolization for treatment of hemorrhage related to spontaneous and induced abortion. Am J Obstet Gynecol 2001; 185 (3) 530-536
- 16 Cheng YY, Hwang JI, Hung SW , et al. Angiographic embolization for emergent and prophylactic management of obstetric hemorrhage: a four-year experience. J Chin Med Assoc 2003; 66 (12) 727-734
- 17 Halperin R, Vaknin Z, Langer R, Bukovsky I, Schneider D. Late midtrimester pregnancy termination in the presence of placenta previa. J Reprod Med 2003; 48 (3) 175-178
- 18 Yamada T, Kasamatsu H, Mori H. Case report: Two cases of placenta previa terminated at 18 weeks' gestation. Kobe J Med Sci 2003; 49 (3–4) 51-54
- 19 Ruano R, Dumez Y, Cabrol D, Dommergues M. Second- and third-trimester therapeutic terminations of pregnancy in cases with complete placenta previa—does feticide decrease postdelivery maternal hemorrhage?. Fetal Diagn Ther 2004; 19 (6) 475-478
- 20 Nakayama D, Masuzaki H, Miura K, Hiraki K, Yoshimura S, Ishimaru T. Effect of placenta previa on blood loss in second-trimester abortion by labor induction using gemeprost. Contraception 2007; 75 (3) 238-240
- 21 Steinauer JE, Diedrich JT, Wilson MW, Darney PD, Vargas JE, Drey EA. Uterine artery embolization in postabortion hemorrhage. Obstet Gynecol 2008; 111 (4) 881-889
- 22 Borrás A, Gómez O, Sanz M, Martínez JM, Puerto B. Feticide followed by mifepristone-misoprostol regimen for midtrimester termination of pregnancy in two cases of complete placenta previa. Fetal Diagn Ther 2010; 28 (2) 114-116
- 23 Lathrop E, Schreiber C. Controversies in family planning: management of second-trimester pregnancy terminations complicated by placenta accreta. Contraception 2012; 85 (1) 5-8