Intraoperative Hemorrhage Requiring Emergent Hysterectomy: Failed Conservative Management of a Cervical Placenta Accreta

Abstract

Abstract

Background:

Emergent peripartum hysterectomy is warranted for a variety of indications, including uterine rupture, uterine atony, retained placenta, and abnormal placentation. Abnormal placentation is an increasingly common phenomenon that can be attributed to disruptions in the endometrial decidua following cesarean delivery, myomectomy, dilation and curettage, endometritis, endometrial ablation, and other operative procedures.

Case:

At 10 weeks of gestation, a patient with two previous cesarean deliveries and two terminations of pregnancy via dilation and curettage underwent a suction dilation and curettage for a missed abortion. Hemorrhage occurred; she became hemodynamically unstable and underwent an emergent total abdominal hysterectomy (TAH).

Results:

Surgical pathology testing confirmed an intracervical pregnancy with a placenta accreta.

Conclusions:

This case highlights the difficulty in differentiating cervical ectopic pregnancy with a spontaneous abortion in process. In order to prevent loss of reproductive function, massive hemorrhage, and possibly maternal mortality, the current authors recommend that, in patients with histories of multiple cervical instrumentations, the risk of cervical ectopic pregnancy and even abnormal cervical placentation must be considered in the preoperative differential. In the unstable patient, the “gold standard” treatment for abnormal placentation—TAH—is warranted when conservative measures, such as balloon tamponade, fail. (J GYNECOL SURG 33:215)