Retained placenta accreta after a first-trimester abortion manifesting as an uterine mass
A 41-year-old gravida 4 para 2 with a history of 1 Cesarean section and 3 dilatation and curettages presented with a complaint of vaginal bleeding. Her cycles were regular initially and became irregular 1 year ago. She was diagnosed with premature menopause at a private clinic and sought evaluation at our hospital. She had 1 full-term vaginal delivery 18 years ago and 1 Cesarean section due to a breech presentation 9 years ago. Several years ago before the Cesarean section, she underwent a dilatation and curettage. Three and six years after the uneventful Cesarean section, she underwent a dilatation and curettage at a local clinic for pregnancies estimated to be about 5 weeks gestation.\nPelvic examination revealed a slightly enlarged uterus. Vaginal ultrasonography revealed a 7.8 × 6.6 × 4.1 cm well-defined complex solid and cystic mass in the uterine wall and there was no vascular flow in the lesion (). All laboratory finding was not remarkable. Serum level of estradiol, prolactin, lutenizing hormone, and follicular stimulating hormone (FSH) were 25.42 pg/mL, 4.8 ng/mL, 32.54 mIU/mL, and 66.13 mIU/mL, respectively. Serum level of β-human chorionic gonadotrophin (β-hCG) was 0.27 mIU/mL. The endometrial line was not visualized. Based on the history and sonographic findings, the differential diagnosis included an endometrial cancer or a uterine myoma with degeneration.\nA diagnostic dilatation and curettage was performed. Friable tissue was recovered and frozen section revealed benign tissue. After evacuation, heavy uterine bleeding continued, and the blood pressure was 70/50 mm Hg, and the pulse rate was 130 beats per minute. An emergency hysterectomy was recommended with consent of the family. At the time of surgery, the uterine surface was shown to be smooth and there were no abnormal findings in the abdominal and pelvic cavity. Her vital signs recovered after transfusion of four units of packed red cells and two units of fresh frozen plasma. A total abdominal hysterectomy and incidental appendectomy were performed. The hysterectomy specimen showed a 9.0×6.0 cm red-brown mass adherent to the myometrium. The histopathlogic examination revealed a retained placenta accreta without atypical trophoblastic cells (). Her postoperative condition remained stable and she had a favorable progress. She was discharged 6 days later.