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

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.

Keywords: cesarean hysterectomy; midtrimester termination; placenta accreta; placenta previa.

Fig. 1

A vaginal ultrasound revealed complete placenta previa covering the internal os in the 20th week of gestation. Multiple placental lacunae were observed.

Fig. 2

(a) Histopathological study of the placenta that failed to deliver spontaneously following cesarean section. The surgery was converted to open hysterectomy. The white arrow indicates the abnormal adherence between the uterine myometrium and placenta. (b) Histopathological analysis of the placenta at 20 weeks of gestation, confirming placenta previa complicated by placenta accreta in the sections numbered 3–6.