I retained the placenta and hemorrhaged after DS's planned homebirth in Dec 2005. I had an emergency transport to the hospital where three docs each attempted to manually remove the placenta without success. I had a d&c and then a transfusion the next day.
Afterwards, my midwife (who was not in the surgery or had seen any reports) said that she believed it was an accreta.
I recently got my surgical and lab reports and I'm wondering if that is an accurate diagnosis. I have an appointment next month with a OB/GYN office to review the records and do a consultation as to future risks but I would really like to hear the insight of women who have been through accretas. What should I ask at the appointment? What do these reports mean? Etc.
Some background:
- I was 27 years old with no history of d&c or cesareans.
- In the beginning of the pregnancy, I had a sinus infection treated with an antibiotic to which I was allergic. Took allegra to deal with the allergy.
- At 37-38 weeks pregnant, I had pnuemonia and was treated with a different antibiotic.
- DS was born at 38w6d for SURE.
- Labor was FAST; 60-90 minutes from recognizable labor signs to finish.
- I lost alot of blood at home and passed some small pieces of the placenta there.
So, here are the pertinent parts of the OR and lab reports. There are certainly some weird parts (like the cord insertion site) but does it really sound like an accreta since it was removed "without difficulty" once they opened me up?
So confused, please advise! Thank you!
10:00-10:30pm Labor begins and is active.
11:30pm water breaks with meconium present.
11:40pm 7#, 8 oz 20" boy born, cord tears at delivery, baby pale, limp, and quiet then grunty. Midiwife had not arrived yet.
12:05am midwife arrives and assesses. Doesn't seemed concerned about baby's condition at this point or meconium, etc. Bleeding normal at first then heavier, pass small pieces of placenta, becoming pale and dizzy, hard contractions and uterus not clamping down.
1:14am call 911
1:20am EMTs arrive
1:43am arrive at ER: "OB/GYN at bedside attempted to remove
the retained products, but there is still retained products and the
patient was transferred emergently to the OR in critical condition.
The patient was rushed to the OR within 17 minutes of her presentatin.
She had critical care time while she was there. The fluid infused
was warmer. She had warm blanket;"
2:15am Transfer to OR for retained products, hypotension, anemia.
"PREOP DX:
1. retained products of conception
2. hemorrhage
POSTOP DX:
1. retained products of conception
2. hemorrhage
OPERATION:
1. Manual removal of retained products of conception
2. Dilation and curettage.
ANESTHESIA: IV sedation
SPECIMENS: Placenta
DRAINS: none
EST. BLOOD LOSS: 100cc
IV FLUIDS: 3500cc
URINE OUTPUT: 22cc via straight cath.
COMPLICATIONS: None. The patient tolerated the procedure well.
PROCEDURE: After coming to the ER with postparum hemorrhage with
retained products of concetption, the patient was given informed
consent and taken to th eoperating room secondare to hemorrhage. The
patient was prepped and draped in the normal sterile fashion. A
sterile speculum was placed in the ****** and the cervix was noted to
be completely dilated with no laceration and the products of
conception were visible. Manual removal of the placenta was then
obtained without difficulty. The cervix was then grasped with a ring
forceps in order to observe and report any cervical laceration, non
were found. The ****** was then inspected for any lacerations. A
small left periurethral tear was noted, but was not bleeeding an
therefore, do not need to be sutured. A horseshe curettage was then
used very gently to curette the uterus to assure no products of
cenception were left behind. There was minimal bleeding. The patient
tolerated the procedure well, and the patient was taken to the
recovery room in stable conditio, and to Pathology, products of
conception."
(Hostboard is blocking "v.a.g.i.n.a" so it appears as *******)
SURGICAL PATHOLOGY FINAL REPORT
"FINAL DIAGNOSIS: Third trimester fragmented, 499 gram placenta -
meconium-stained fetal membranes.
COMMENT: umbilical cord was not identified in the specimen.
MICROSCOPIC DESCRIPTION: Microscopic examination has been performed
and corresponds to the Final Diagnosis.
CLINICAL INFORMATION: Retained products of conception and placenta.
GROSS DESCRIPTION: "Retained products of conception/placenta."
Received in formalin is a 499 gram fragmented placenta. Upon partial
reconstruction the placental disc is ovoid and is 23.0 x 15.0 x 4.0
cm. There is a scant rim of opaque membranes which have a bright
green hue. A segment of umbilical cord i+ not recognized on the
placental disc or separate within the specimen container. It appears
to insert in a velamentous fashion as there are several large caliber
vessels within the extraplacental membranes and a+ insertion site is
not identified on the placental disc. The fetal surf+++ is a light
blue with a dark green hue and the amnion is partially strip++++.
Approximately 25% of the maternal surface is torn and friable with
poss+++ areas of missing cotyledons. There is a diffuse layer of
calcifications. Cut surfaces are pale pink and spongy and contain
diffuse layer of intraparenchy+++ calcification. Focal abnormalities
are not recognized. Representative sections are submitted in three
cassettes."
(my copy of the report has missing letters on the right margin, hence the ++)
