PC-OB38 : Conservative management of retained placenta accreta postpartum

We report conservative treatment of retained placenta accreta, including residual placenta in situ following delivery with placenta accreta. This report was approved by the Institutional Review Boards (IRB) of CHA Bundang Medical Center (IRB No.2018-08-018). Retained placenta accreta is considered a gold standard diagnosis to examine the placental invasion degree on normal myometrium by histological examination after removal of the placenta residual tissues after delivery. Diagnosis of placenta accreta in the prenatal period is a life threatening condition in which the placental villi invade into the myometrium. The well- known etiology is associated with a defect in the decidua basalis, which allows villi to invade into the myometrium and occasionally into tissues beyond. Retained placenta accreta is difficult to diagnose during antenatal care period and it is mainly discovered during the delivery time, when enormous and uncontrollable postpartum hemorrhage occurs. Although the placenta is removed manually or with force, the maternal morbidity and mortality may be high, so the management of retained placenta accreta is inevitable encountered in an unavoidable situation in which the placenta cannot be completely removed at delivery. The surgical treatment of retained placenta accreta, which sometimes requires hysterectomy might be related to the degree and size of placental invasion and the obstetric risks that arise at that time. But in this article, we have encountered two cases which successfully recovered by conservative treatment without cesarean hysterectomy or other surgical treatment. We report two women with conservative treatment of retained placenta accreta and describe the prospective monitoring of the clinical course, placental regression, and recovery of the uterine anatomy using serial two dimension (2D) ultrsonography. There was no secondary serious postpartum complication and a normal menstrual cycle had returned. To save fertility, invasive treatment such as hysterectomy may be avoided with abnormal placental adherence through close follow up progress observation leaving residual placenta in adhesion placenta. Retained placenta accreta is difficult to diagnose in the series of processes of delivery. It is usually discovered after delivery, when enormous and uncontrollable postpartum hemorrhage occurs. Histological examination of placental residual tissue is the gold standard for the diagnosis of retained placenta accreta and gives the degree of placental invasion into the myometrium. If the placenta is removed by force, maternal morbidity and mortality would be high. Therefore, management of retained placenta accreta is essential when the placenta cannot be completely spontaneously or manually delivered. We present a case of retained placenta accreta that was successfully managed by conservative treatment avoiding hysterectomy or other additional surgical treatments. There were no secondary serious postpartum complications and the menstrual cycle returned to normal.