Angular placenta attachment

A report describes a case of a 30-year-old Japanese primigravida who conceived spontaneously and started pregnancy checkups in China. She presented with 28 gestational weeks after moving to Japan and showed no complications until giving birth to a healthy 3212 g female infant by spontaneous vaginal delivery at 39 weeks. 

The patient received intravenous oxytocin after delivery, but the placenta remained attached even after a 30 min third stage. An ultrasound showed the location of the placenta in the uterine fundus on the right side, with an extremely thin local myometrium. Thus, the physicians diagnosed it as the case of a retained placenta due to interstitial or angular pregnancy. The lack of severe hemorrhage and the patient's wish to retain her uterus directed the physicians to leave the placenta in situ and waited for its spontaneous separation. CT and magnetic resonance imaging (MRI) confirmed the diagnosis of interstitial or angular pregnancy, revealing an enlarged right uterine angle with thin myometrium. 

The patient developed a persistent fever over 38.0 °C on a postpartum day (PPD) 6; thus, the physicians suspected intrauterine bacterial infection and started intravenous antibiotic therapy. On PPD 9, the patient experienced a small amount of vaginal bleeding. The physicians found the spontaneous movement of the placenta, in an ultrasound, toward the center of the uterus. They infused oxytocin, and the placenta got delivered without significant bleeding. The patient's temperature normalized on PPD 11, and she received a discharge on PPD 13.

Nakatsuka E, et al. Conservative management for adherent placenta after live birth in angular or interstitial pregnancies: A new entity "angular placenta attachment." Taiwanese Journal of Obstetrics and Gynecology. 2020;59(6):975-979. https://doi.org/10.1016/j.tjog.2020.09.033.

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