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

Abstract

Placenta previa is an obstetric complication in which the placenta is attached over the lower uterine segment. When associated with placenta accreta, the risk of massive obstetric hemorrhage is increased. 1 The established risk factors for placenta accreta are prior cesarean delivery and placenta previa. 1 Despite extensive research on the management of placenta previa (including placenta accreta, increta, and percreta), 2-6 the number and quality of studies are limited. Moreover, termination of pregnancy (TOP) due to placenta accreta in the second trimester is rare, and the management of this condition is both controversial and rarely reported. We present a case of placenta accreta requiring a complicated induced second-trimester abortion because of premature rupture of the membranes (PROMs). We terminated the pregnancy using intravaginal gemeprost. During the termination , massive hemorrhaging occurred, necessitating subsequent hysterectomy. Here, we discuss the case and present a review of the related literature. Keywords ► placenta previa ► placenta accreta ► midtrimester termination ► cesarean hysterectomy 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.