"Leaving the placenta in situ approach" (LISA) in a patient with placenta increta leading to delayed spontaneous delivery of the placenta. (17th January 2020)

• Record Type: Journal Article
• Authors: Boekhoff, Jelena; Arabin, Birgit; Figiel, Jens; Köhler, Siegmund
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 33:Number 2(2020)
• Page Start: 341
• Page End: 343
• Publication Date: 2020-01-17
• Subjects: FIGO recommendations -- magnetic resonance imaging -- placenta percreta -- placenta previa -- postpartum hemorrhage; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2018.1488960
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Aim: Based on the recent FIGO recommendations, we wish to report on preservation of the uterus in a patient with placenta increta by applying the leaving the placenta in situ approach. Methods: A 30-year-old gravida 2, Para 1 was referred at 25 + 5 gestational weeks due to a placenta previa bipartita increta diagnosed by transvaginal ultrasound, a history of a cesarean and vaginal bleeding. After informed consent, the parents opted for conservative treatment. The patient was admitted and the options of treatment were communicated within a multidisciplinary team. At 31 + 4 gestational weeks, severe recurrent hemorrhage led to a repeat cesarean. Results: A boy of 1910 g was delivered and the placenta was left in situ . Estimated blood loss was <200 ml. An MRI on day 13 still showed regular placental circulation, but after 4 weeks, perfusion and HCG levels had significantly decreased. The patient was examined every 3 days and readmitted after 6 weeks with a sudden rise of d -dimers. Within 24 hours, the complete placenta was delivered. On postoperative day 54, MRI confirmed uterine involution without a placental tissue. Conclusions: Delayed placental delivery in patients with abnormal placental invasion is a legitimate option to preserve fertility and possibly to reduce intrapartum hemorrhage.