A case of placenta previa with increta with a history of pelvic radiation

Abstract

Background: Prior pelvic radiation increases risks of pregnancy complications that can be life threatening. No documented pregnancy has successfully occurred with pelvic radiation dosing of >45 Gy. This case report describes a successful conception after receiving 54 Gy with subsequent severe pregnancy complications.Case34 yo G4P2012 with a history of pelvic radiation who presented with painless vaginal bleeding at 12w6d gestation resulting from a donor egg embryo transfer. She was subsequently diagnosed with a subchorionic hemorrhage, complete placenta previa, and placenta increta leading to a gravid hysterectomy at 23w0d due to concern for hemodynamic instability.

Conclusion: History of pelvic radiation increases risk of severe life-threatening pregnancy complications. This case report details the complications that can arise to provide assistance for counseling and management for future providers.

Keywords: Conception; Placenta increta; Previa; Radiation.

Fig. 1

(Documented as A-D from left to right): A) Sagittal T2-weighted image demonstrates placenta previa (asterisk) with thinning of the cervix and protrusion of the placenta into the cervical canal. B) Parasagittal T2-weighted image demonstrates focal crescentic T2 hypointense signal anteriorly at the placental-myometrial interface (blue arrow) likely representing a small amount of subchorionic hemorrhage. C) Coronal T2-weighted image demonstrates marked thinning of the myometrium with discontinuity along the left inferolateral aspect suggestive of placenta percreta (white arrowhead). D) Oblique axial T2-weighted image demonstrates marked thinning and lobulation of the placental-myometrial interface (yellow arrowheads).

Fig. 2

A) Midline vertical incision exposing the uterus. B) Specimen after removal. C) Dilated cervix with exposed placenta.