ABSTRACT
INTRODUCCIÓN: Las alteraciones en la placentación son causa importante de morbilidad materna y neonatal y, en ocasiones, de mortalidad. La literatura científica menciona la posible asociación entre acretismo placentario y alteraciones en los parámetros bioquímicos para aneuploidía, sin descripciones de casos en que coincidan estos dos hallazgos. OBJETIVO: Este es un reporte de caso de una gestante con placenta percreta y producto con trisomía 13 REPORTE DE CASO: Gestante de 34 años, gesta 4 cesáreas 2, abortos 1, vivos 2, con embarazo de 20.4 semanas, sin antecedentes de importancia, con hallazgos en ecografía de iii nivel de alteraciones morfológicas en el sistema nervioso central, onfalocele, malformación cardiaca y deformidades en miembros. Con doppler de placenta que evidencia placenta mórbidamente adherida variedad percreta; hallazgos ecográficos confirmados con el estudio anatomopatológico. CONCLUSIONES: La trisomía 13 es una condición genética que debido a las múltiples malformaciones asociadas se considera incompatible con la vida, la placenta mórbidamente adherida se ha asociado con morbimortalidad neonatal y fetal, la no evidencia en la literatura de estas dos condiciones asociadas puede ser debido a la interrupción temprana de las gestaciones en las que se confirma el primer diagnóstico.
BACKGROUND: Alterations in placentation are an important cause of maternal and neonatal morbidity and, sometimes, deaths. The scientific literature mentions the possible association between placental accreta and alterations in the biochemical parameters for aneuploidy, without descriptions of cases in which these two findings coincide. OBJECTIVE: This is a case report of a pregnant woman with placenta percreta and trisomy 13, in which an ultrasound and pathological analysis were made. The use of keywords, in different databases, did not yield information that directly comply with these associations. CASE REPORT: A 34-year-old pregnant woman, G4C2A1V2 with a 20.4-week pregnancy, without significant medical records, with findings at III level ultrasound of morphological alterations of the central nervous system, omphalocele, cardiac malformation and limb deformities. Also, with placental Doppler that evidences morbidly adhered placenta variety percreta; ultrasound findings confirmed with the pathological study. CONCLUSION: The morbidly adhered placenta has been associated with neonatal and fetal mortality, in which some of the identified causes of fetal death are congenital anomalies. This way this case report allows for the first time to describe the association of placental accreta with aneuploidy, type trisomy 13, demonstrated by the morphological alterations of the pathological and karyotype study.
Subject(s)
Humans , Female , Pregnancy , Adult , Placenta Accreta/diagnostic imaging , Placenta, Retained/diagnostic imaging , Trisomy 13 Syndrome/diagnostic imaging , Placenta Accreta/pathology , Congenital Abnormalities , Ultrasonography, Prenatal , Placenta, Retained/pathology , Trisomy 13 Syndrome/pathologyABSTRACT
The incidence of retained products of conception [RPOC] has been reported as 1-3% and ultrasound has an important role in their diagnosis and selection of patients for surgical management. The aim of this study is to identify that ultrasound is a predictor of the presence of retained product of conception [RPOC] within the uterine cavity in women with the clinical diagnosis of incomplete first trimester abortion. hundred patients with a diagnosis of incomplete abortion and RPOC based on clinical and sonographic findings were enrolled. The gold standard test was pathologic reports of samples obtained during dilatation and curettage. Endometrial thickness and homogenesity of the endometer were determined by sonography. The sensitivity and specificity of the measurements for detecting RPOC were assessed. Histopathological reports confirmed the diagnosis of RPOC in 71 patients [71%]. Mean endometrial thickness with RPOC was 16.3 mm versus 12.1 mm without RPOC. Heterogenic endometrium was seen in 56 out of 71 patients [78%]. The sensitivity and specificity of the endometrial thickness greater than 11.25mm for detecting RPOC were 81% and 45%, respectively. Regarding the endometrial thickness and heterogenic endometer, 13.5 mm had the best performance criteria with 60% and 63% sensitivity and specificity, respectively. An endometrial thickness of 11.25 mm or more detected by sonography had the best diagnostic efficacy, considering the heterogenecity with the thickness of the endometrium, 13.5 mm had the best performance criteria for detection of RPOC following first trimester spontaneous abortion