Placenta Accreta - Diagnosis and Management

Placenta accreta is a potential grievous obstetric condition that calls for a multidisciplinary timely management. Placenta accreta refers to placenta that is firmly adherent to the myometrium.1 Three types of adherent placental attachments are, placenta accreta (the uterine decidua is absent and the chronic villi attaches to the myometrium directly), placenta increta (the chronic villi invades into the myometrium), and placenta percreta (the villi penetrate the myometrium up to the serosal layer).2The incidence of placenta accreta has increased ten-fold in the past 50 years.3 It can lead to excessive bleeding, haemorrhagic and neurogenic shock, sepsis, uterine inversion, or need for hysterectomy.4Previous obstetrics interventions like caesarean deliveries are the largest risk factor for the placenta accreta, or previous dilatation and curettage or previous manual removal of placenta. Increasing maternal age and parity, as well as other uterine surgeries also have increased risks. When placenta accrete is suspected, a multidisciplinary team with expertise should be there to take care of such cases. Although ultrasound and magnetic resonance image (MRI) may or may not indicate clearly an invasive placenta, the final diagnosis is made intra-operatively and is supported by histopathological examination.4Placenta accreta is associated with high morbidity and mortality of the mother and the foetus and has high demands on health resources. Antepartum haemorrhage may occur in such cases if there is associated placenta previa. MRI is the best modality for diagnosis when there is suspicion of placenta accreta clinically.

Rapunzel Syndrome with Small Bowel Malrotation

A bezoar refers to a mass of indigestible foreign material found in the gastrointestinal tract, mainly stomach. The second most common bezoar is the trichobezoar, which usually occurs in the young psychiatric female patients with history of trichotillomania and trichophagia.1Malrotation is an abnormal position of the duodenojejunal junction bowel within the peritoneal cavity and usually involves both the small and the large bowel. Malrotation is accompanied by abnormal bowel fixation by mesenteric bands or absence of fixation of portions of the bowel, leading to increased risks of bowel obstruction, acute or chronic volvulus, and bowel necrosis. The term malrotation applies to a wide range of intestinal anomalies, from a readily apparent omphalocele in newborns to asymptomatic nonrotation of the large and small bowel in adults.2This is a case report of a 18 -year-old female patient came with complaints of nausea, vomiting on and off, constipation and fullness of abdomen. Ultrasound, X-ray abdomen erect, and Computed Tomography scan were done, which suggested trichobezoar and small bowel malrotation.

Ovarian Serous Cystadenofibroma- A Rare Tumour

Ovarian cystadenofibroma is a relatively rare benign ovarian tumour that contains both epithelial and fibrous stromal components. It is usually seen during the fourth and fifth decades. This tumour has features of malignancy in ultrasound and may also macroscopically appear as malignant during surgery. Since this tumour has a rare malignant potential, it is well-advised to be aware of the possibility of a cystadenofibroma before selecting an aggressive surgical approach in young patients. Ovarian cystadenofibroma is a relatively rare benign tumour that is seen in women aged 15–65 years.[1] The routine imaging features of this tumour may mimic a malignant neoplasm, but the presence of the fibrous component often gives a specific/characteristic MRI appearance that may help differentiate it from malignant ovarian tumours.[2–5]

An unusual case of ruptured noncommunicating rudimentary horn pregnancy at 10 weeks

Unicornuate uterus with noncommunicating rudimentary horn occurs due to incomplete fusion of mullerian ducts. Pregnancy in this horn is a rare phenomenon usually resulting in rupture during second trimester of pregnancy. Prerupture diagnosis of pregnancy in rudimentary horn with ultrasonography is technically difficult, with sensitivity of 30%. We report a case of ruptured non-communicating rudimentary horn at 10 weeks 3 days in a woman. She had a routine USG before pregnancy in which diagnosis was missed. Later she presented to emergency in shock, with massive hemoperitoneum and ruptured horn. So, a high index of suspicion is required to save this catastrophic event and associated maternal morbidity and mortality.