Published online Nov 6, 2018. doi: 10.12998/wjcc.v6.i13.675
Peer-review started: July 31, 2018
First decision: August 20, 2018
Revised: August 23, 2018
Accepted: August 28, 2018
Article in press: August 28, 2018
Published online: November 6, 2018
Processing time: 99 Days and 4 Hours
Placenta previa is the main cause of bleeding throughout pregnancy, and it is associated with serious complications, such as infection, that lead to a poor prognosis. Gynecological sonography is recommended as the first-line examination technique for the surveillance and determination of vaginal bleeding and for early intervention. We report the case of a patient with gradually expanded hypoechoic lesion and extremely high serum α-fetoprotein level during her third trimester, and discuss their potential relationship in evaluating the progression of placental necrosis.
Core tip: Placental necrosis with extremely high maternal serum α-fetoprotein (AFP) is rare. We reported a 23-year-old female patient with central placenta previa suffered from repeated vaginal bleeding. Follow-up ultrasonography revealed a gradually enlarging hypoecho between the amniotic sac and the uterine myometrium. Until 32 wk of gestation, laboratory results showed extremely elevated maternal serum AFP. Both intraoperative exploration of the placenta and histological examination demonstrated the hypoechoic area was necrotic tissue. To our knowledge, this is the first report of a rare case of extreme AFP level in placental necrosis. Clinicians should consider the combination usage of quantitative ultrasound imaging and AFP as a practical tool for assessing placental lesions.