Successful conservative surgical management of first-trimester placenta accreta: Case report.

Autor:	Souayeh N; Department of Gynecology and Obstetrics, Ben Arous Regional Hospital, Ben Arous, Tunisia; Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia. Electronic address: nesrine.souayeh@fmt.utm.tn., Smida H; Department of Gynecology and Obstetrics, Ben Arous Regional Hospital, Ben Arous, Tunisia; Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia., Rouis H; Department of Gynecology and Obstetrics, Ben Arous Regional Hospital, Ben Arous, Tunisia; Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia., Lika A; Department of Gynecology and Obstetrics, Ben Arous Regional Hospital, Ben Arous, Tunisia; Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia., Mbarki C; Department of Gynecology and Obstetrics, Ben Arous Regional Hospital, Ben Arous, Tunisia; Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia., Bettaieb H; Department of Gynecology and Obstetrics, Ben Arous Regional Hospital, Ben Arous, Tunisia; Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia.
Jazyk:	angličtina
Zdroj:	International journal of surgery case reports [Int J Surg Case Rep] 2024 Sep; Vol. 122, pp. 110172. Date of Electronic Publication: 2024 Aug 13.
DOI:	10.1016/j.ijscr.2024.110172
Abstrakt:	Introduction and Importance: Placenta accreta spectrum in the first trimester is a rare but life-threatening condition. Its diagnosis and management remain challenging due to the lack of diagnostic criteria and therapeutic guidelines. This case report emphasizes the importance of early diagnosis of first trimester placenta accreta to perform fertility-sparing management. Case Presentation: A 29-year-old gravida 2 para 1 woman, with history of cesarean delivery, presented with abnormal uterine bleeding. On physical examination, she had minimal vaginal bleeding with normal haemodynamic parameters. An endovaginal ultrasound revealed a non-viable fetus and a low implanted gestational sac. Cesarean scar pregnancy (CSP) was suspected. The patient underwent an ultrasound-guided uterine dilatation and curettage, complicated with massive bleeding. Before an emergency laparotomy was carried out, bleeding was controlled with a Foley catheter balloon. Conservative management was performed with bilateral hypogastric artery ligation followed by the placenta accreta niche resection. Pathology confirmed first-trimester placenta accreta. Clinical Discussion: Placenta accreta spectrum disorders can occur even in the first trimester. Traditionally, hysterectomy has been the treatment of choice, but conservative management is possible with careful case selection and monitoring. Careful preoperative planning, including multidisciplinary consultation, is key to improving maternal outcomes. Maintaining high index of suspicion for placenta accreta spectrum disorders, and early diagnosis through ultrasonography, is crucial in the first trimester to perform fertility-sparing surgical management. Conclusion: Placenta accreta spectrum incidence is increasingly rising. First-trimester placenta accreta should be suspected in high-risk situations. Conservative management can be offered in selected cases. Competing Interests: Declaration of competing interest Authors declared they have no conflicts of interest. (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu