Placenta Previa Increta como causa de Hemorragia Obstétrica

Abstract

Placenta previa is defined as the total or partial insertion of the placenta in the lower segment of útero. La incidence is estimated to be 1 in every 200 pregnancies to term and varies throughout the world. It seems to have increased relative to the increasing rate of births cesárea.

It is classified as complete, partial and marginal, depending on how the placenta covers the opening endocervical.

According to the degree of penetration of abnormal placentation three types are recognized: accreta, increta, percreta.

We present the case of female patient of 33 years old that causes pregnancy 22 weeks 5 days with reproductive background of sharp curettage 3 years ago. Go to the emergency room to present in moderate vaginal bleeding, bright red, with clots, accompanied by crampy abdominal pain located in lower abdomen. Enter hemodynamically stable. An ultrasound trace is reported total occlusive placenta previa.

It remains hospitalized for about 3 months in the HPDA, at 35.3 weeks outpatient reports crystal clear liquid in small quantities, positive crystallography. Patient with uterine activity sporadic transfer is decided by lack of physical space to IESS in Ambato with a pregnancy of 35.3 weeks LMP + premature rupture of membranes 48 hours of evolution + previa low set + fetal distress, is valued and decide their intervention performing a caesarean surgical segmental abdominal hysterectomy + bilateral + adnexectomy.

Post-surgical patient remains in recovery of 35.3 weeks + increta placenta previa, pregnancy patient is discharged in good general condition. Histopathological confirms increta placenta.

Early prenatal approach through non-invasive diagnostic imaging provides useful information on the commitment and extension in the evaluation of patients with risk factors for placenta accreta. Ultrasonography is the method of choice, leaving magnetic resonance imaging and the study as a confirmatory histopathology as the gold standard definitive diagnosis and image.

The only safe and proper method of delivery for placenta previa is a cesarean delivery. It is essential in all hospitals that treat obstetric patients evaluate and implement strategies to achieve a significant reduction in maternal morbidity and mortality. The ideal is to have a contingency plan on therapeutic conduct to follow, so that each case must be individualized. However, there are specific conditions of these high-risk pregnancies that require rapid decision-making, which should ideally be carried out in highly complex centers with highly trained professionals’ health to optimize final results thus reducing the maternal risks fetal.