The Feasibility of Conservative Management for Morbidly Adherent Placenta Accidentally Encountered after Vaginal Delivery.

OBJECTIVE: To evaluate the feasibility of conservative management for patients with morbidly adherent placenta (MAP) accidentally encountered after term vaginal delivery.

METHODS: Medical records of patients with MAP who were accidentally encountered after term vaginal delivery and treated in our hospital from January 2009 to December 2015 were retrospectively reviewed.

RESULTS: A total of 8 eligible patients were included in this analysis. Primary postpartum hemorrhage occurred in 5 (62.5%) cases. Emergent uterine artery embolization, intrauterine balloon occlusion, and blood transfusion were performed in 5 (62.5%), 2 (25%), and 2 (25%) cases, respectively. Placentas were left in situ in all these 8 cases. Subsequent adjunctive medication treatments, including methotrexate, mifepristone, and traditional Chinese medicine, were administered in 7 (87.5%), 4 (50%), and 3 (37.5%) cases, respectively. The retained placenta spontaneously passed out in 4 (50%) patients. Additional curettage operation was performed in 3 (37.5%) patients. Emergent hysterectomy was performed in 1 (12.5%) patient due to cardiac insufficiency and acute pulmonary edema caused by sepsis. No other severe adverse events were identified.

CONCLUSIONS: Conservative management is feasible for patients with MAP accidentally encountered after vaginal delivery with close follow-up.