Unconventional Management of Partial Placenta Accreta for Uterine Preservation: A Case Report

TL;DR

A unique approach to managing partial placenta accreta preserved the patient's uterus and resolved bleeding through expectant management and later surgical intervention.

Contribution

This case report presents an unconventional management strategy for partial placenta accreta aimed at uterine preservation.

Findings

Expectant management followed by hysteroscopic resection successfully preserved the uterus in a patient with partial placenta accreta.

The Mirena IUD insertion helped manage postpartum bleeding after removal of retained placental tissue.

Abstract

We present the case of a 35-year-old G2P1102 who underwent a unique approach to managing partial placenta accreta for uterine preservation. The patient was diagnosed with atypical hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and subsequently underwent a repeat cesarean delivery at 36 weeks of gestation. Intraoperatively, approximately 5% of the placenta was determined to remain adherent to the uterine cavity. Initial attempts at complete placental removal were unsuccessful. After hemostasis was obtained, it was decided that the patient would undergo expectant management with close observation. At the six-week postpartum appointment, retained products of conception were suspected, contributing to ongoing uterine bleeding. Hysteroscopic tissue resection and dilation, and curettage were used to remove remnant placental tissues, then the Mirena intrauterine device (IUD) was inserted at the end. The procedure was successful, preserving the uterus and resolving the patient's bleeding. This case highlights a potential alternative approach to managing partial placenta accreta. Further research is needed to evaluate the efficacy and safety of this method in broader clinical practice.

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