Eva Mariana Flores Rosas

Egresado del Hospital de la Mujer, Ciudad de México

Title: Placentary acretism in the first quarter of pregnancy as a cause of hypovolemic shock: a case report


BACKGROUND: Accreta is the abnormal adherence of the placenta to the myometrium, due to the partial or total absence of the decidua basalis and the incomplete development of the Nitabuch layer. It is responsible for the second cause of obstetric hemorrhage.
OBJECTIVE: To present a clinical case of hypovolemic shock secondary to placental accreta in the first trimester.
CLINICAL CASE: 45-year-old multigesta, 12-week amenorrhea, upon admission he presents loss of alertness, T / A 40/20, B-HCG fraction of 2878 mU / ml, posterior cervix, dehiscent, abundant transvaginal bleeding, integrates diagnosis of incomplete abortion in the first trimester, active management of shock is started and is admitted to the obstetric surgical unit, an instrumented uterine curettage is performed, bleeding persists during the procedure for which an exploratory laparotomy is decided, finding placental accreta in the anterior uterine wall, Obstetric hysterectomy and therapeutic hypogastric artery ligation with GALA technique, he was admitted to the intensive care unit, he was kept under management with amines for 24 hours, later favorable evolution, a control hematic biometry was taken at 72 hours that reported a hemoglobin of 8.6 g / dl, discharge without complications.
CONCLUSIONS: The case of a patient with hypovolemic shock secondary to placental accreta in an abortion of 12 weeks of gestation is presented. There are few reported cases of placental accreta in the first trimester of pregnancy, and it may even be the first case reported in our country.