"Leaving the placenta in situ approach" (LISA) in a patient with placenta increta leading to delayed spontaneous delivery of the placenta

• Published in: The journal of maternal-fetal & neonatal medicine Vol. 33; no. 2; pp. 341 - 343
• Main Authors: Boekhoff, Jelena, Arabin, Birgit, Figiel, Jens, Köhler, Siegmund
• Format: Journal Article
• Language: English
• Published: England 17-01-2020
• Subjects: Adult; Cesarean Section - methods; Conservative Treatment - methods; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Magnetic Resonance Imaging; Placenta - pathology; Placenta Accreta - diagnostic imaging; Placenta Accreta - therapy; Postpartum Hemorrhage - therapy; Pregnancy; Ultrasonography, Prenatal; postpartum hemorrhage; magnetic resonance imaging; placenta percreta; placenta previa; FIGO recommendations
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2018.1488960

Based on the recent FIGO recommendations, we wish to report on preservation of the uterus in a patient with placenta increta by applying the leaving the placenta
approach.
A 30-year-old gravida 2, Para 1 was referred at 25 + 5 gestational weeks due to a placenta previa bipartita increta diagnosed by transvaginal ultrasound, a history of a cesarean and vaginal bleeding. After informed consent, the parents opted for conservative treatment. The patient was admitted and the options of treatment were communicated within a multidisciplinary team. At 31 + 4 gestational weeks, severe recurrent hemorrhage led to a repeat cesarean.
A boy of 1910 g was delivered and the placenta was left
. Estimated blood loss was <200 ml. An MRI on day 13 still showed regular placental circulation, but after 4 weeks, perfusion and HCG levels had significantly decreased. The patient was examined every 3 days and readmitted after 6 weeks with a sudden rise of d-dimers. Within 24 hours, the complete placenta was delivered. On postoperative day 54, MRI confirmed uterine involution without a placental tissue.
Delayed placental delivery in patients with abnormal placental invasion is a legitimate option to preserve fertility and possibly to reduce intrapartum hemorrhage.