Conservative Management of Morbidly-Adherent Placenta Following Vaginal Deliveries: A Case Series

Background: A morbidly adherent placenta can be anticipated in deliveries preceded by uterine surgeries or procedures; however a few cases occur without any apparent risk factor and require a high index of suspicion. A proper diagnosis and management can avert a catastrophe. Most cases in the literature were reported following caesarean deliveries with resultant abdominal laparotomy. A rare mention is made of morbidly adherent placenta following vaginal deliveries. Cases: Two cases of morbidly adherent placentae in middle aged women were reported and managed conservatively. There were no apparent risk factors. Both patients had uterotonics and prophylactic antibiotics with satisfactory outcomes. The two later resumed menstruations and one had a successful pregnancy and delivery subsequently. Conclusion: Morbidly adherent placenta can be managed conservatively in well selected cases following vaginal delivery. Simple use of uterotonic, analgesic and antibiotics can prevent a laparotomy with its attendant complications. *Corresponding authors: Dr. Akinwuntan Akinwunmi L, Premier Specialists Medical Centre, Victoria Island, Lagos, Nigeria, Tel: +2348034715026; E-mail: [email protected] Received January 03, 2013; Accepted January 30, 2014; Published February 02, 2014 Citation: Akinwuntan Akinwunmi L, Oshinowo Omololu S (2014) Conservative Management of Morbidly-Adherent Placenta Following Vaginal Deliveries: A Case Series. Gynecol Obstet (Sunnyvale) 4: 207. doi:10.4172/2161-0932.1000207 Copyright: © 2014 Akinwuntan Akinwunmi L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Morbidly adherent placenta is an obstetric complication with potentially grave maternal outcomes [1,2]. It occurs due to placental invasion of the decidual with varying degree of severity from placenta accreta (short of the myometrium), placenta increta (limited to the myometrium) and placenta percreta (beyond the myometrium involving the serosa and occasionally other pelvic organs like the bladder and bowels). It often presents with massive post-partum haemorhage resulting in caesarean hysterectomy [3]. The incidence has been reported to be from 1 in 2000 to 1 in 533 deliveries [4]. It has been on the increase as a result of a rise in uterine surgeries especially caesarean sections and myomectomies. There is a vast resource of cases following caesarean operations with little mention of adherent placentae following vaginal deliveries. In recent times, a more conservative approach to management is advocated with the placenta left in-situ using medical regimen and interventional radiological approach such as uterine artery embolization. These not only preserve fertility in well selected cases, it also reduces the morbidities that follow radical approach of caesarean hysterectomy.