Published: 2017-02-10

A rare case report of hysterotomy for retained placenta accreta in bicornuate uterus

Reena Sharma, Amit Gupta, Usha K. Chaudhary, Ajay Sharma, Arvind Kumar


Retained placenta is a common third stage complication. Placenta accreta is due to abnormal invasive placental implantation. Many cases of Post-partum haemorrhage (PPH) are caused by placenta accreta and may lead to peripartum hysterectomy. We here report a case of placenta accreta in a patient following two failed attempts of manual removal of retained placenta followed by conservative management with methotrexate in stable patient. Both attempts were unsuccessful and led to septicaemia, requiring delivery of placenta by hysterotomy.


Retained placenta, Placenta accreta, Methotrexate

Full Text:



Hughes EC, editor. Obstetric-gynecologic terminology: with section on neonatology and glossary on congenital anomalies. Philadelphia (PA): F.A. Davis;1972.

OyeleseY. SmulianJC. Placentaprevia, placenta accreta and vasa previa. Obstet and Gynecol. 2006;107(4):927–41.

Tong SY P, Tay KH, Kwek YCK, Conservative management of placenta accreta: review of three cases. Singapore Medical Journal,2008;49(6):156–9.

TimmermansS. VanHofAC. DuvekotJJ. Conservative management of abnormally invasive placentation. Obstetrical and Gynecological Survey. 2007;62(8):529–39.

Hudon L, Belfort MA, Broome DR. Diagnosis and management of placenta percreta: a review Obstet Gynecol Survey1998;53:509-17.

Gordon JE. Gideo H. Wyon JB. Midwifery practices in rural Punjab, India. American Journal of Obstetrics & Gynecology.1965;93(5):734–42.

Warshak CR. Eskander R. Hull AD. Scioscia AL. Mattrey RF. Benirschke K et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol. 2006;108:573-81.

Comstock CH. Love JJ Jr. Bronsteen RA. Lee W. Vettraino IM. Huang RR et al. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Am J Obstet Gynecol. 2004;190:1135-40.

Mussalli GM. Shah J, Berck DJ, Elimian A, Tejani N, Manning FA. Placenta accreta and methotrexate therapy: three case reports. J Perinatol. 2000;20:331-4.

Butt K. Gagnon A. Delisle MF. Failure of methotrexate and internal iliac ballon catheterization to manage placenta percreta. Obstet Gynecol. 2002;99:981-2.

Obstetrics: normal and problem pregnancies (4 Ed.). New York, NY [U.A.]: Churchill Livingstone. 2002. P.519.

Johnston TA. Paterson-Brown S. (January 2011). Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management. Green-top Guideline No. 27. Royal College of Obstetricians and Gynecologists.

Pliskow. Steven. Dai. Xiaorong. Kohner. Andrew. Kapnick. Jason. Conservative surgical management of placenta accreta, a report of three cases. The journal of reproductive medicine. 2009;54:636-9.

Knight M. UKOSS. Peripartum hysterectomy in UK: management and outcomes of the associated haemorrhage. British Journal of Obstetrics and Gynecology. 2007;114:1380-7.

Eller AG. Bennett MA. Sharshiner M. Masheter C. Soisson AP. Dodson M et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric obstetric care. Obstet Gynecol. 2011;117:331-7.

Comstock CH. Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol. 2005;26:89-96.

Combs CA. Laros RK. Prolonged third stage of labour: morbidity and risk factors. Obstet Gynecol. 1991;77:863-7.

Tandberg A. Albrechtsen S. Iverson OE. Manual removal of placenta. Acta Obstet Gynecol Scand. 1999;78:33-6.

Collaborating Centre for Women and children’s Health (NCCWCH) National Intrapartum Care. Care of Healthy Women and their Babies during Child birth, RCOG Press, London, UK, 2007.

WorldHealthOrganization (WHO), Pregnancy, Childbirth, Postpartum and new born Care: A Guide for Essential Practice, WHO, Geneva, Switzerland, 2ndedition, 2006.

Weeks AD. The retained placenta, Best Practice & Research: Clinical Obstetrics and Gynaecology. 2008; 22(6):1103–17.

Jansen RPS, Elliott PM. Angular intrauterine pregnancy. Obstetrics & Gynecology. 1981;58(2):167–75.

Acien P. Incidence of Mullerian defects in fertile and infertile women. Human Reproduction 1997;12:1372–6.

Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Human Reproduction Update 2001;7:161–74.

Sentilhes L, Ambroseli C, Kayem G, Provansal M, Fernandez H, Perrotin F et al. Maternal outcome after conservative treatment of placenta accreta. Obstetrics and Gynaecology. 2010;115:526-34.

Arul Kumaran S, Ng CS. Ingemarsson I. Ratnam SS. Medical treatment of placenta accreta with methotrexate. Acta Obstetrics et Gynecologica Scandinavica. 1986;65:285-6.

Crespo R, Lapresta M, Madani B. Conservative management of placenta increta with methotrexate. International Journal of Gynecology and Obstetrics. 2005;91:162-3.

Timmermans S, Van Hof AC. Duvekot JJ. Conservative management of abnormally invasive placentation. Obstetrical and Gynecological Survey. 2007;62(8):529–39.

Kayeg G, Davy C, Goffinet F, Thomas, Clement D, Cabrol D. Conservative versus extirpative management in cases of placenta accreta. Obstetrics and Gynecology. 2004;104(3):531–6.

BretelleF, CourbiereB, MazounietalC. Management of placenta accreta: morbidity and outcome. European Journal of Obstetrics Gynecology and ReproductiveBiology.2007;133(1):34–9.