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Exaggerated Placental Site as a Cause of Hysterectomy for Massive Bleeding After First Trimester Voluntary Abortion

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Abstract

Objectives

Placental implantation anomalies in first-trimester abortions may determine severe bleeding leading to hysterectomy. There are very few cases of urgent hysterectomy post-abortion reported in the literature, related to placenta accreta spectrum, but in any of them is considered association with benign trophoblastic lesions.

Methods

We report the case of a woman, who underwent surgical voluntary abortion by vacuum aspiration during first trimester, without any apparent surgical complications. Immediately, after this procedure, the patient had massive vaginal bleeding; an emergency hysterectomy was performed. Histological examination showed an exaggerated placental site (EPS).

Results

Morphological findings describe a trophoblastic tumor-like lesion, which differs from placenta accreta and often considered an asymptomatic occasional feature. Proliferative index, evaluated by double immunostain for CK8-18 and Ki-67, was unremarkable (<1%).

Conclusions

Only a single report in the literature describes a case of symptomatic EPS 65 after first-trimester abortion. Major attention should be paid to trophoblastic pathology in order to understand a possible relationship with uterine bleeding and to find a clinical, ultrasound or chemical indicator.

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Authors and Affiliations

  1. Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari,, ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124, Bari, Italy

    Antonio Pellegrino, Francesco Davide Campanelli, Mario Villa, Gianluca Raffaello Damiani, Cristina Riva & Emanuele Dainese

Authors
  1. Antonio Pellegrino
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  2. Francesco Davide Campanelli
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  3. Mario Villa
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  4. Gianluca Raffaello Damiani
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  5. Cristina Riva
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  6. Emanuele Dainese
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Corresponding author

Correspondence to Gianluca Raffaello Damiani.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in this study were in accordance with ethical standard of institutional and national research committed and Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained by the patient.

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Antonio Pellegrino, director of obstetrics and gynecology alessandro manzoni hospital; Francesco Davide Campanelli, MD of university of bari; Mario Villa, MD of alessandro manzoni hospital; Gianluca Raffaello Damiani, MD surgeon-obstetrician of policlinico bari university of bari; Cristina Riva, director of pathologic anatomy of alessandro manzoni; Emanuele Dainese, pathologist of alessandro manzoni hospital

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Pellegrino, A., Campanelli, F.D., Villa, M. et al. Exaggerated Placental Site as a Cause of Hysterectomy for Massive Bleeding After First Trimester Voluntary Abortion. J Obstet Gynecol India 72, 463–465 (2022). https://doi.org/10.1007/s13224-021-01469-y

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  • DOI: https://doi.org/10.1007/s13224-021-01469-y

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