A 31 years old female presented with bleeding per vaginam for one and half month with soakage of 6 to 7 pads per day and passage of clots. There was a history of termination of 3 months' pregnancy 53 days back by suction and evacuation. Her obstetric history was para1, live 1, spontaneous abortion1, and MTP 1. On examination her general condition was fair, mild pallor was present, pulse and Blood pressure were normal. Abdomen was soft and nontender, pfannensteil scar was present. On per speculum examination, fresh as well as altered coloured bleeding seen. On per vaginal examination, uterus was 8 weeks size, soft, approximately 3×3cm nontender nodule felt in the right fornix.
All routine blood investigations were within normal limits. Serum beta HCG level was less than 50 mIU/ml. Ultrasongraphy and MRI reports were suggestive of placenta increta with no obvious parametrial involvement but CT angiography showed right uterine artery pseudoaneurysm in the distal portion with surrounding hematoma. The patient was counseled about the two treatment options - uterine artery embolization (UAE) and hysterectomy. In view of possibility of the lesion being placenta increta despite a CT angiography report being to the contrary, the inability of the UAE to remove the mass present and her inability to afford UAE, she opted for hysterectomy.
An exploratory laparotomy was performed. Intraoperative finding were uterus enlarged to 6-8 weeks' size, ballooned out area at the junction of isthmus and cervix, and normal adnexae. A total hysterectomy was performed. Specimen was cut opened showed 5×4cm adherent mass at the junction of isthmus and cervix. Postoperative recovery was uneventful. Histopathology report showed placenta increta.
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Valvi D, Parulekar SV. Placenta Increta Masqurading as Uterine Artery Pseudoaneurysm