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A 34-year-old woman at 31+5 gestacional week (GW) comes to emergency because she had broken the membranes. Ultrasonography revealed placenta previa anterior, lacunar spaces and uterine myometrial deficiency between the placenta and bladder wall.The Doppler and RMI showed feeding vessels and hipervascularity of the uterine-bladder interface. The case was discussed and the decision was to perform an ultrasound evaluating fetal growth and lung maturation and according to these propose the ideal moment for the end. The cesarean section was planned for 32+3 GW. At that time, laparotomy, revealed large blood vessels and placental penetration through the anterior uterine wall and determined that separating the bladder would be extremely difficult. It was performed a vertical uterine incision to avoid the placental, and successfully delivered a healthy female infant. Hysterectomy was dismissed because of the high risk of bleeding. After the cesarean, she was subjected to an embolization of the hypogastric arteries Post-surgical follow-up were performed analytic controls, ultrasound and RMI. A month after, the patient was discharged, continuing with outpatient controls. Five days later she comes to the control referring abdominal pain, 38,5ºC and oliguria reason why, decides admission and 3 days later, due to worsening and a CAT with signs of abscessing at the uterine, it was decided to perform total abdominal hysterectomy.The surgery confirmed the presence of an abscessed. The results of the cultures taken at surgery reported E.coli infection. The postoperative course was favorable. PP is the most severe variant of placenta accreta. The standard treatment for PP is cesarean hysterectomy; however, some surgeons choose conservative management to avoid potential intraoperative complications. Although conservative management can avoid maternal morbidity, several complications, including sepsis, intravascular coagulation, massive hemorrhage, and delayed hysterectomy, have been reported. [ABSTRACT FROM AUTHOR]

Chorioangioma is the most common histological type of placental tumors with a reported incidence ranging from 0.2% to 0.6%. It consists in a benign angioma arising from primitive angioblastic tissue of the placenta. Tumors less than 5 cm are usually symptomless, but when large, they may be associated with severe maternal and fetal complications probably because of arteriovenous shunts. They are mostly seen in multiple pregnancies and in female babies. Doppler ultrasound examination is the gold standard in primary diagnosis. The fetal outcome may be predicted by the vascularity intensity of the placental mass. We report an unsuccessful case of a large chorioangioma diagnosed in the second trimester resulting in polyhydramnios and neonatal death. A 35-year-old third gravida presented to us at 24 weeks with history of abdominal distension and exacerbating dyspnea in the past 15 days. There was no significant maternal medical history. The infections study was negative. The ultrasound showed severe polydramnios (AFI: 44 cm), and a well-defined and vascularized echogenic mass measuring 55 x 55 mm was seen bulging on the fetal side. There was no gross structural abnormalities. The size of the placental tumor increased from the time of diagnosis to the end of pregnancy (89 x 77mm the last measurement). Maternal Nonsteroidal Anti-Inflammatory Drugs therapy and two amnioreductions were performed with drainage of a large quantity of amniotic liquid. Steroid administration for acceleration of fetal lung maturity was given. The fetal heart rate tracing always revealed reduced variability and no accelerations. At 29 weeks patient went into spontaneous preterm labor with apparent decelerations on the fetal trace. Due to suspicion of monitoring maternal frequency, an ultrasound was performed displaying intrauterine death. A female baby was born, weighing 1950g. She had a post-partum hemorrhage controlled by uterine compression, fibrinogen and oxytocic drugs. Macroscopic and microscopic examination confirmed the diagnosis of chorioangioma. The fetal autopsy revealed changes of chronic and recurrent hypoxia episodes, as well as an edema and vascular congestion affecting main part of tissues. Although chorioangioma is rare, it should be considered as differential diagnosis in case of polydramnios. Large chorioangioma presenting with severe polyhydramnios is associated with a poor outcome, as in this case. Post-partum hemorrhage is a well-known maternal complication. It is important to understand until when we can delay the pregnancy termination. Close fetal monitoring helps in timely diagnosis and delivery. [ABSTRACT FROM AUTHOR]

The increasing incidence of placenta accreta is closely linked to increased deliveries by caesarean section. Antenatal diagnosis of morbidly adherent placenta is important in improving maternal and fetal outcome, therefore necessitating sensitive and specific diagnostic modalities in predicting placenta adhesiva. One such modality is ultrasonography. Proper ultrasonographic examination and the use of Placenta Accreta Index are able to predict up to 96% cases in high risk populations, defined by previous history of caesarean section. We report two cases of placenta adhesiva with 2x history of Caesarean section in Gatot Soebroto Central Army Hospital, Indonesia, obtained by ultrasound during antenatal care. PAI scoring yielded 96% and 69% prediction in each cases, both of which were proven to be placenta adhesiva through intraoperative and histopathological findings. PAI scoring is able to provide guideline to the obstetrician in predicting cases of placenta accreta, prepare a better multidisciplinary management, and improve maternal and fetal outcome. [ABSTRACT FROM AUTHOR]

Asherman's syndrome is a rare condition, characterized by total or partial obliteration of the uterine cavity by uterine synechiae, which occur mostly after curettage or surgery in pregnant or puerperal uterus. This is a recognized cause of infertility as well as repetitive miscarriages. The case presented here refers to a 40-year-old pregnant woman with an obstetric history of a cesarean section (CST) 10 years ago and a medical abortion due to trisomy 21 requiring uterine curettage 4 years ago. After this date and in view of the etiological investigation of repetitive spontaneous abortions, the diagnosis of Asherman's Syndrome was corroborated by hysteroscopy. Surveillance started at our Maternal Fetal Medicine Consultation at 20 weeks of gestation, at the time of the late pregnancy diagnosis, for the antecedents previously mentioned, and for right breast neoplasia diagnosed 1 year ago and submitted to quadrantectomy. The histological diagnosis was compatible with highgrade intra-ductal carcinoma in situ with negative sentinel ganglion. Pregnancy surveillance was uneventful. She was hospitalized for labor induction (ITP) at 40 weeks + 3 days for gestational age and for obstetrical and gynecological history. It was submitted to cross-sectional CST for apparent fetal-pelvic incompatibility, with the birth of a newborn (RN) female, 3785 gr, Apgar 9/10, healthy. At the third stage of labor, the presence of placental accretion was noted, and a sub-total hysterectomy was performed, which occurred without intercurrences. The pathological anatomy corroborated the diagnosis of placenta increta. In conclusion, in view of the high risk of complications associated with a pregnancy after the diagnosis of Asherman's syndrome, it is extremely important to evaluate and adequately guide these pregnant women during prenatal and perinatal surveillance [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the experience of reducing blood loss and time of surgical intervention in patients with placenta accrete in the Perinatal Center, Rostov-on-Don, Russia. Materials and methods. Retrospective analysis of all cases of patients with placenta accrete in the Rostov-on-Don Perinatal Center was conducted from 2014 to 2017. Prophylactic measures to prevent hemorrhage, duration of surgery and its volume and operative techniques were analyzed. The statistical analysis was performed using Mann-Whitney U-test. Results. 76 patients with placenta accrete were divided into 4 groups. Group I included 35 (40%) pregnant women, whom endovascular methods of reducing blood loss (balloonization of common iliac arteries, selective embolization of uterine arteries) were performed. II group included 9 (12%), whom ligation of internal iliac arteries was performed. In III group (9 (12%) women) Foley catheter No.16 was used temporary on the inner cervical os and funnel-pelvic ligaments (Shmakov RG, etc. 2017). IV group consisted of 23 (30%) women, whom methods of preventing massive blood loss were not applied. The duration of surgical intervention in group III (1 hour 42 minutes±8.9 minutes) was statistically less than in group I (2 hours 10 minutes±7.1 minutes, p<0.0001), group II (1 hour 51 minutes±4.1 minutes, p<0.05) and in group IV (2 hours 44 minutes±9.6 minutes, p 0.000 ). The total blood loss in group I (M±σ) was 2 4 . ± 8.8 ml; II group - 2277.8±114.9 ml; III group - 1144.4±194.4 ml; in IV group - 4430.4±437.9 ml. The blood loss in group III was significantly less than in groups I, II and IV (p<0.0001). Metroplastic was performed in all women of group III. Conclusion. Use of a temporary Foley catheter is a reliable, effective, inexpensive and simple method of preventing massive blood loss during a cesarean section associated with placenta accrete. [ABSTRACT FROM AUTHOR]

The incidence of placenta abnormalities have been increasing in last two decades1. The range is about 1:2510 bis 1:533 in large cohort-studies2,3.The risk increases from 3% after one Sectio caesarea up to 6.7% after four Sectios4. The obstetricians are considered to recognize more placenta abnormalities especially after sectio caesarea delievery. In this way we could decrease the mortality obstetrics rate. A case report from our center, 41-years old,grav.5 , para.4, about 33 weeks pregnant, after previous 2x sectio deliveries,was referred because of abnormal bleeding. Prenatal care was diagnosed with total placenta praevia. We could recognise during ultrasound scan 11 from 13 pathonogmonic signs from European Working Group on Abnormally Invasive Plazenta (EW-AIP). We just diagnosed abnormal placenta adherent ( placenta increta). The next step was interdisciplinary board meeting between obstetricians, urology , anesthesiology , and pediatricians in our center. We did the caesaria delivery simultaneously with hysterectomy after informed consent to our patient in 36 weeks. The operation was done after insertion double lumen ureteral cathether by urology in order to avoid the ureter lession. Estimated blood loss about 2000 ml, substituted with 2 packs erythrocyte concentrate blood transfusions. An iatrogenic bladder perforation during the operation could be effectively managed. The newborn is vital and appropriate for gestational age. Postoperative urinary tract infection could be completely cured.Histological findings confirm our diagnose placenta increta. The criterias from EW-AIP ( European Working Group on Abnormally Invasive Placenta )are in BModus , colour doppler , and 3 D. B-Modus criterias are loss retroplacenta hypoechogen areas, abnormally lacunae ,thin myometrium wall (<1mm), abnormally contour from placenta placental bulging ,or focal exophytic mass). Colour doppler ultrasound scan confirms uterovesikale hypervascularisation, subplacenta hypervascularisation,placenta-myometrane bridging vessels, and blood flow in lacunae. With 3D ultrasound scan confirms all criterias showed in volume mass 5. Abnormally invasive placenta has high mortality and morbidity risks. A well trained ultrasound specialist should recognize this case. In case of severe abnormally invasive placenta with completed family planning, we are in opinion for sectio hysterectomy. The operation should consider inter - disciplinary departments in order to reduce the mortality rate as well as to manage any logical complication. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the potential impact of adenomyosis on the pregnancy outcomes by retrospectively investigating adenomyosis-complicated pregnancy cases. Methods: We performed a retrospective case-control study. Forty-nine singleton pregnancy cases complicated with adenomyosis were included in this study. The controls (n = 245) were singleton pregnant women without adenomyosis and were frequency matched to adenomyosis cases by age, parity, and the need for assisted reproductive technology for this conception. The incidence of obstetrical complications and delivery and neonatal outcomes were examined. Results: Patients in the adenomyosis group were significantly more likely to have a second trimester miscarriage (12.2% vs 1.2%, odds ratio (OR): 11.2, 95% confidence interval (95% CI): 2.2-71.2), preeclampsia (18.3% vs 1.2%, OR: 21.0, 95% CI: 4.8-124.5) , placental malposition (14.2% vs 3.2%, OR: 4.9, 95% CI: 1.4-16.3), and preterm delivery (24.4% vs 9.3%, OR: 3.1, 95% CI: 1.2-7.2), compared with the control group. Conclusion: Adenomyosis was associated not only with an increased incidence of preterm delivery, as previously reported, but also with an increased risk of second trimester miscarriage, preeclampsia , and placental malposition, which could lead to poor perinatal outcomes. [ABSTRACT FROM AUTHOR]

Placental mesenchymal dysplasia (PMD) has an estimated incidence of 0.02%. The essence of the disease is placentomegaly and grape-like placental vesicles. As the similarity of the ultrasound image between PMD and molar pregnancy is substantial, it is vital to properly differentiate those two conditions. 25 years old woman in second pregnancy had no abnormalities detected on first trimester ultrasound scan. The calculated risk of trisomy was low. The ultrasound scan at 19 weeks revealed a single female fetus with no anatomical abnormalities. Abnormal, "jelly-like placenta" with numerous cysts was observed. At 25 weeks intrauterine growth restriction with abnormal Doppler was diagnosed and the patient was referred to the hospital. During hospitalization the blood pressure was normal and deterioration in Doppler scan was observed. The patient was administered intramuscular betamethasone. At 27 weeks abnormal cardiotocography was found. Due to imminent fetal asphyxia, female newborn weighting 740 grams was promptly delivered via cesarean section. Placenta contained numerous cysts (diameter up to 4 cm). The placenta karyotype was triploid (69 XXY), while the newborn karyotype was diploid (46 XX). Histopathological examination indicated PMD. Maternal serum βHCG level was not elevated (5 mIU/mL). Early postoperative period was complicated by hypertension of 200/100 mmHg and two eclampsia attacks. The patient received hypotensive and anticonvulsive treatment and magnesium sulfate infusion. Computer tomography examination revealed hypodense change in frontal lobe. The patient was transferred to neurological intensive care unit, where she was diagnosed with posterior reversible encephalopathy syndrome (PRES) on MRI. Abnormal placentation, including PMD is related to a higher risk of preeclampsia and eclampsia. It should be borne in mind that pregnant women with pregnancies complicated with PMD are at increased risk of eclampsia and pulmonary embolism and, therefore, they ought to be provided with adequate information and intense pregnancy monitoring. [ABSTRACT FROM AUTHOR]