RESUMEN
RATIONALE: Currently, placenta accreta treatment mainly includes nonconservative surgical and conservative treatments such as Traditional Chinese medicine (TCM). This report describes the case of a 37-year-old woman who suffered incomplete placenta accreta after vaginal delivery and was cured by TCM. TCM treatment of placenta accreta has its own unique advantages, including low toxicity and few side effects, unaffected breastfeeding, and retention of the uterus, which can ensure the expulsion of residual placenta and be beneficial to patients' physical and mental health. PATIENT CONCERNS: Symptoms included a small amount of vaginal bleeding and occasional lesser abdominal pain. The patient showed lesser abdominal tenderness, a red tongue moss with petechial hemorrhage, and a hesitant pulse. The reproductive history was G3P2L2A1. In addition, the patient was afraid of having her uterus removed due to incomplete placental separation. DIAGNOSES: The case was diagnosed as placental accreta. Ultrasound is the preferred method of diagnosis, and biomarkers, such as beta hCG, assist in screening for placental accreta. Doppler ultrasonography showed that in the bottom of the right uterine cavity, there was an uneven echo group of 7.6â×â4.6âcm, which was not clearly demarcated from the posterior wall; the muscle layer became thinner, with a thinnest part of 0.19âcm, and abundant blood flow signals were observed (Fig. 1JOURNAL/medi/04.03/00005792-202102190-00086/figure1/v/2021-02-16T234818Z/r/image-tiff). The beta hCG was 580.92âmIu/ml. INTERVENTIONS: The patient initially underwent curettage therapy 9âdays after delivery, but it failed due to excessive intraoperative bleeding. The patient then turned to TCM treatment. The doctor prescribed a multi-herbal formula. OUTCOMES: After 4âmonths, the residual placenta was expelled, and the patient's symptoms disappeared completely. No adverse and unexpected events occurred during treatment. During 3âmonths of follow-up, the patient had no abdominal pain, abnormal vaginal bleeding, or other complications. LESSONS: This study shows that TCM is safe and effective for treating placenta accreta, and it is worth recommending TCM as a conservative treatment along with other treatments. In practice, however, we find that the earlier TCM treatment is applied, the better the effect; therefore, early intervention with TCM is particularly important.
Asunto(s)
Medicina Tradicional China/métodos , Placenta Accreta/diagnóstico por imagen , Placenta Accreta/terapia , Ultrasonografía Doppler/métodos , Adulto , Cuidados Posteriores , Gonadotropina Coriónica Humana de Subunidad beta/metabolismo , Tratamiento Conservador/métodos , Femenino , Humanos , Placenta Accreta/metabolismo , Embarazo , Resultado del Tratamiento , Hemorragia Uterina/etiologíaRESUMEN
To explore the clinical value of stage operation to patients with placenta accreta after previous caesarean section (CS).Nineteen women with medium and late pregnancies diagnosed with placenta accreta after previous CS were enrolled in this retrospective study and all underwent stage operation. Postpartum hemorrhage volume, red blood cells (RBC) transfusion, uterus retention rate, postpartum complications, and menstrual recovery were analyzed to evaluate the value of stage operation in patients with placenta accreta.Four of 19 cases were performed uterus curettage after 63, 38, 56, and 52 days of CS. Total hysterectomy was performed in 2 cases after 44 and 57 days of first-stage CS. Thirteen cases had placenta well discharged after treatment with the traditional Chinese medicine (TCM) Shenghua Decoction. The uterus retention rate was 89.48% (17/19). Mean postpartum hemorrhage volume was 1594.74â±â1134.06 (400-4500) mL, mean volume of total hemorrhage was 1878.42â±â1276.96 (400-4500) mL, mean RBC transfusion was 868.42â±â816.53 (0.00-2400.00) mL. Postpartum bleeding volume showed≤1000 mL in 8 patients and ≤500 mL in 4 patients.Stage operation reduces postpartum hemorrhage volume and cesarean hysterectomy morbidity in patients with placenta accreta. However, infection and late postpartum hemorrhage should be monitored closely.