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Case Reports in Obstetrics and Gynecology
Volume 2017, Article ID 6070732, 6 pages
https://doi.org/10.1155/2017/6070732
Case Report

Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion

1Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
2Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
3Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA

Correspondence should be addressed to Jaimin Shah; ude.cmt.htu@hahs.nimiaj

Received 24 August 2017; Accepted 24 September 2017; Published 18 October 2017

Academic Editor: Giampiero Capobianco

Copyright © 2017 Jaimin Shah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The detection of a morbidly adherent placenta (MAP) in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal placental implantation. If these patients have a first trimester missed abortion and fail medical management, it is important that providers have a heightened suspicion for a MAP. Case. A 24-year-old G4P3003 with 3 prior cesarean deliveries underwent multiple rounds of failed medical management for a missed abortion. She had a dilation and curettage that was complicated by a significant hemorrhage and ultimately required an urgent hysterectomy. Conclusion. When patients fail medical management for a missed abortion, providers need to assess the patient’s risk factors for a MAP. If risk factors are present, a series of specific evaluations should be triggered to rule out a MAP and help further guide management. Early diagnosis of a MAP allows providers to coordinate a multidisciplinary treatment approach and thoroughly counsel patients. Ensuring adequate resources and personnel at a tertiary hospital is essential to provide the highest quality of care and improve outcomes.