Chronic abnormally adherent placenta: A case report

Abstract

We present an unusual case of retained placental products with concern for placenta accreta six weeks following a spontaneous vaginal delivery in a primiparous woman. A 19-year-old female presented to us as a transfer of care secondary to vaginal bleeding six weeks following her delivery. Imaging at outlying facility revealed retained placental products with concern for possible accreta as well as a possible mullein anomaly. She also reported a suction dilation and curettage immediately following her delivery as well as a subsequent suction dilation and curettage two weeks after the initial. Abdominal imaging revealed retained placental products with concern for placenta accreta due to her clinical situation. The patient was given a single dose of methotrexate. This treatment regimen was successful in helping the patient pass the remaining products of conception without invasive surgery or surgical loss of fertility. Retained placenta with imaging concerning for placenta accreta in the setting of a primiparous women is a clinical oddity and is often associated with definitive surgical treatment via a hysterectomy. This case report reveals less invasive and fertility sparing option which may be appropriate for certain patients.