Placenta percreta with congenital uterine abnormality in a primigravida: A case report

Kervindran, Mohanasundaram and Christine, Lee Mui Fong and Soe, Lwin and Lai, Qi Ji and Harris, Suharjono (2021) Placenta percreta with congenital uterine abnormality in a primigravida: A case report. Med J Malaysia, 76 (3). ISSN 0300-5283

PDF placenta1.pdf Download (30kB)

Abstract

Abnormal placentation is typically seen in patients with risk factors, usually a history of uterine surgery, and follow up for these cases would be tailored accordingly. This a case of placenta percreta in a primigravida with congenital uterine abnormality noted during surgery. Case Description: A 41-year-old primigravida with gestational diabetes mellitus on metformin presented at 20 weeks of pregnancy with acute abdomen without per vaginal bleeding. Physical examination revealed a distended abdomen with generalized tenderness, and bedside scan revealed a viable fetus within uterus with low lying placenta and some free fluid in the abdomen. She was normotensive but tachycardic, with a hemoglobin of 8 g/dL (her booking hemoglobin was 11.3 g/dL). Formal ultrasound was reported as perforated appendicitis. Intraoperatively placenta percreta with uterine rupture was diagnosed, with the entire amniotic sac expelled out. Noted unicornuate uterus with rudimentary horn; patient did not have left ovary and Fallopian tube. Subtotal abdominal hysterectomy was done. The fetus did not survive. HPE was reported as placenta percreta with uterine fibroid. Discussion: An online search revealed less than 10 similar cases being reported, and they mostly were of a younger-age group. This patient also had a history of subfertility for 5 years that was not previously investigated. Due to her age factor, she was referred for detailed scan however she presented 2 weeks before her scheduled appointment with the MFM team. Pregnant primigravida in acute abdomen with free fluid should raise suspicion for possibility of abnormally invasive placenta and congenital uterine abnormality

Actions (For repository members only: login required)

View Item