Intrapartal resection of the bicornuete uterus for placenta membranacea percreta

Abstract

Placenta membranacea is a rare anomaly characterized by failure of villous atrophy during early gestation, and 30% of cases involve some form of placental adherence. Placenta percreta is infrequent, but life-threatening condition. Antenatal diagnosis of these placental anomalies is very difficult, but essential for reduction of the number and extent of possible complications. A 19-year-old primigravida was referred to us with 31- week pregnancy complicated by preeclampsia. Upon admission, ultrasound scan revealed eutrophic fetus in breech presentation, without any signs of retroplacental clot. At laparotomy, hemoperitoneum without any trophoblastic tissue emerging to the peritoneal cavity was found and placental abruption with uteroplacental apoplexy was suspected. In addition, unicervical symmetric bicornuate uterus with pregnancy in the left uterine horn was found. The lower segment uterine section was performed and 1800 grams live baby was delivered. Delivery of the placenta was unusually difficult. It was very large and densely adherent to the posterior uterine wall, which appeared to be composed of serosa in that area only. After removal of placenta, the hemorrhage could not be controlled, and resection of the left uterine horn was performed. Placenta accreta, increta and percreta ought to be considered in all cases of uterine anomalies in pregnancy and in cases of prenatal diagnosis of placenta membranacea.