Zhao P, Zhao Y, He J, Bai XX, Chen J. Subsequent placenta accreta after previous mifepristone-induced abortion: A case report. World J Clin Cases 2021; 9(33): 10244-10248 [PMID: 34904095 DOI: 10.12998/wjcc.v9.i33.10244]
Corresponding Author of This Article
Jian Chen, MD, Chief Physician, Department of Ultrasonography, the Fourth Affiliated Hospital Zhejiang University School of Medicine, No. N1 Shangcheng Dadao, Yiwu 322000, Zhejiang Province, China. chenjianzuj4h@zju.edu.cn
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Peng Zhao, Ying Zhao, Department of Obstetrics, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
Jing He, Xiao-Xia Bai, Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Jian Chen, Department of Ultrasonography, the Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
Author contributions: Zhao P and He J designed the research study; Zhao P and Zhao Y performed the literature research; Zhao P, Zhao Y, Chen J and Bai XX contributed data acquisition and data analysis; Zhao P and Zhao Y wrote the manuscript; He J, Bai XX and Chen J critically revised the manuscript; All authors have read and approved the final manuscript.
Informed consent statement: Written informed consent for publication was obtained from the patient.
Conflict-of-interest statement: The authors declared no conflict of interest with respect to the research, authorship, and publication of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Chen, MD, Chief Physician, Department of Ultrasonography, the Fourth Affiliated Hospital Zhejiang University School of Medicine, No. N1 Shangcheng Dadao, Yiwu 322000, Zhejiang Province, China. chenjianzuj4h@zju.edu.cn
Received: March 17, 2021 Peer-review started: March 17, 2021 First decision: April 13, 2021 Revised: September 22, 2021 Accepted: October 14, 2021 Article in press: October 14, 2021 Published online: November 26, 2021
Abstract
BACKGROUND
Mifepristone-induced abortion (MIA) has been used worldwide to terminate pregnancies. However, the association between placenta accrete (PA) and MIA has seldom been reported.
CASE SUMMARY
A 26-year-old pregnant woman presented with painless vaginal bleeding at 35 wk of gestation. She had a medical abortion (mifepristone followed by misoprostol) 1 year ago at the sixth week of gestation. Her personal history for previous surgery was negative. Abdominal ultrasonography showed a normal foetus with complete placenta previa. The foetal membrane ruptured with massive vaginal bleeding and severe abdominal pain. An emergency Caesarean section was performed, and the newborn was delivered. The placenta failed to expel and manual extraction was carried out. A large defect was noted in the uterine fundus and repair of the uterine rupture was conducted immediately. The postoperative pathology report showed placenta accreta.
CONCLUSION
The evidence suggests a possible etiologic role of MIA in PA, as the incidence of PA after MIA is much higher than general population. Millions of pregnancies are complicated by PA each year, some of which result in fatality. To prevent subsequent placental complications after MIA, hormonal supplementation might be a promising therapeutic options. However, further studies are needed to identify the high-risk factors and to confirm the effectiveness of estrogen supplement therapy.
Core Tip: The main findings of the current study are (1) a potential association between placenta accrete (PA) and mifepristone-induced abortion (MIA); and (2) the prevalence of PA after MIA has been neglected and underestimated for a long time. Millions of pregnancies are complicated by PA each year, some of which result in fatality. To prevent subsequent placental complications after MIA, hormonal supplementation might be a promising therapeutic option. However, further study is needed to identify risk factors and to confirm the effectiveness of estrogen supplement therapy.
