PMC6232829_01
Ultrasonography appearance of a lacunary placenta.
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An ultrasonographic examination revealed an ongoing viable pregnancy, anamnios and a low-lying anterior placenta with multiple lacunae (Figure 1).
Ultrasonography aspect of the placenta increta fragment.
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An ultrasound performed immediately postabortion revealed only a 3 cm isthmic and echoic image suggestive of a retained placenta increta (Figure 2).
MRI aspect of the anterior uterine sacculation containing the placenta increta fragment with blood clots.
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It also led to a suspected uterine scar dehiscence with possible loss of substance at this level (Figure 3).
Operative view of anterior uterine sacculation.
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A surgical exploration revealed an unruptured isthmic hernial pocket, covered by the peritoneum and traversed by multiple dilated veins (Figure 4).
Operative view of the opening of the sac containing placenta increta and blood clots.
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Conducting a transverse hysterotomy to open the hernial sac enabled us to easily detach the vesicouterine peritoneum and to evacuate the hematoma (Figure 5).
Operative view of the hysterorrhaphy after resection of the sac and its contents.
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The walls of the sac were then resected along with the increta placental fragments and then a hysterorrhaphy was performed without difficulty by separate points (Figure 6).