1. What is the most likely diagnosis?
2. What is your next step in management for this patient?
Answer And Discussion:
1. What is the most likely diagnosis?
Answer: Placenta accreta.
2. What is your next step in management for this patient?
Answer: Hysterectomy.
Placenta Accreta:
This patient has had two previous uterine incisions, which increases the risk of placenta accreta. The placenta is noted to be very adherent to the uterus, which is the clinical definition of placenta accreta, although the histologic diagnosis requires a defect of the decidua basalis layer. The usual management of true placental accreta is hysterectomy since attempts to remove a firmly attached placenta often lead to hemorrhage and/or maternal death. Conservative management of placenta accreta, such as removal of as much placenta as possible and packing the uterus, often leads to excess mortality as compared to immediate hysterectomy. Nevertheless in a younger patient who strongly desires more children, this option may rarely be entertained.
Definitions:
PLACENTA ACCRETA: Abnormal adherence of the placenta to the uterine wall due to an abnormality of the decidua basalis layer of the uterus. The placental villi are attached to the myometrium.
PLACENTA INCRETA: The abnormally implanted placenta penetrates into the myometrium.
PLACENTA PERCRETA: The abnormally implanted placenta penetrates entirely through the myometrium to the serosa. Often invasion into the bladder is noted.
Risk Factors: Risk factors for placental adherence include:
- low-lying placentation or placenta previa,
- prior cesarean delivery
- previous history of uterine curettage,
- prior myomectomy.
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I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
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