[Placenta percreta: a rare aetiology of metrorrhagies in the first and second trimesters of pregnancy about two cases and review literature]

ABSTRACT

The placenta percreta is an abnormal placentar adhesion with invasion of all the uterine wall with sometimes an extension to the organs bordering the womb by chorial villiosities. It is a pathology rarely diagnosed during the first trimester of pregnancy. We report in this work two cases of placenta percreta diagnosed in the first trimester of pregnancy in the A service of the centre of maternity and of neonatology of Tunis. After a review of the literature we tried to make lignt on risk factors inherent to this pathology and to propose a practical behaviour. The first patient of the study was 28 years old, with bicicatricial uterus. She was admitted in urgency for abundant metrorragies in the tenth week of pregnancy, A molar pregnancy was suspected and an attempt of uterin evacuation failed. In front of the importance of bleeding an haemostais hysterctomy was made. The second patient was 39 years old, and had as antecedents of cures of uterine synechy. She was admitted in the 19[th] week of pregnancy, for a late abortion. In front of the complete placentar retention and the aggravation of bleeding, the diagnosis of placenta accreta was evoked and a haemostasis hysterectomy was realized. In both cases histological exam confirmed peroperative discoveries and concluded the diagnosis of placenta percreta. The difficulty of the management of the placenta percreta is due to the fact that this pathology is almost always met in a unexpected way in an urgent context. Antenatal diagnosis is recently described as possible in the first trimester of pregnancy