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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (4): 600-603    DOI: 10.31083/j.ceog.2020.04.5227
Case Report Previous articles | Next articles
Placenta percreta at 33 weeks of gestation after laparoscopic radiofrequency ablation for adenomyosis and Conservative Surgical Treatment: A case report and review of literature
H.S. Song1, Y.A. Kim1, *()
1Department of Obstetrics and Gynecology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
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Radiofrequency ablation (RFA) has been proposed as an alternative to hysterectomy for treatment of uterine fibroids and adenomyosis. Until now, there have been no prospective studies published investigating fertility and pregnancy outcomes after RFA of myomas. A 31-weeks pregnant woman who had undergone laparoscopic RFA about 3 years ago was admitted to our hospital with abdominal pain. During conservative treatment, the patient complained of very painful abdominal gas and recurrent variable deceleration was observed without uterine contractions in the cardiotocography. An emergency cesarean was performed, and placenta percreta with active bleeding on the posterior wall of the uterus was found, along with multiple placental percreta lesions. She was discharged from the hospital on the seventh day after conservative surgery with a good overall condition. To our knowledge, this is the first case of placenta percreta after RFA for adenomyosis.

Key words:  Placent percreta      Radiofrequency ablation      Adenomyosis     
Submitted:  15 April 2019      Accepted:  06 June 2019      Published:  15 August 2020     
*Corresponding Author(s):  Y.A. Kim     E-mail:

Cite this article: 

H.S. Song, Y.A. Kim. Placenta percreta at 33 weeks of gestation after laparoscopic radiofrequency ablation for adenomyosis and Conservative Surgical Treatment: A case report and review of literature. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 600-603.

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Figure 1.  — Cardiotocography performed on complaining severe abdominal pain. Recurrent variable decelerations (arrows) were observed without uterine contraction.

Figure 2.  — Placental percreta was observed on the fundus (A), anterior (B) and posterior wall(C) of Uterus, and uterine perforation(C, thick arrow) with active bleeding was observed on the posterior wall.

Figure 3.  — The endometrium (arrow) was observed in normal form on ultrasound, which was performed six months.

[1] Devlieger R., D’Hooghe T., Timmerman D.: “Uterine adenomyosis in the infertility clinic”. Hum. Reprod., 2003, 9, 139-147.
[2] Bergamini V., Ghezzi F., Cromi A., Bellini G., Zanconato G., Scarperi S. et al.: “Laparoscopic radiofrequency thermal ablation: A new approach to symptomatic uterine myomas”. Am. J. Obstet. Gynecol., 2005, 192, 768-773.
doi: 10.1016/j.ajog.2004.10.591 pmid: 15746670
[3] Ghezzi F., Cromi A., Bergamini V., Scarperi S., Bolis P., Franchi M.: “Midterm outcome of radiofrequency thermal ablation for symptomatic uterine myomas”. Surg. Endosc., 2007, 21, 2081-2085.
doi: 10.1007/s00464-007-9307-8
[4] Farquhar C., Brosens I.: “Medical and surgical management of adenomyosis”. Best Pract Res Clin Obstet Gynaecol, 2006, 20, 603-616.
doi: 10.1016/j.bpobgyn.2006.01.012 pmid: 16563872
[5] Rabinovici J., Stewart E.A.: “New interventional techniques for adenomyosis". Best Pract Res Clin Obstet Gynaecol, 2006, 20, 617-636.
doi: 10.1016/j.bpobgyn.2006.02.002 pmid: 16934530
[6] Cramer M.S., Klebanoff J.S., Hoffman M.K.: “Pain is an independent risk factor for failed global endometrial ablation”. J Minim Invasive Gynecol, 2018, 25, 1018-1023.
doi: 10.1016/j.jmig.2018.01.020 pmid: 29374620
[7] Philip C.A., Le M., Maillet L., de Saint-Hilaire P., Huissoud C., Cortet M., et al.: “Evaluation of novasure((r)) global endometrial ablation in symptomatic adenomyosis: A longitudinal study with a 36 month follow-up”. Eur J Obstet Gynecol Reprod Biol, 2018, 227, 46-51.
doi: 10.1016/j.ejogrb.2018.04.001 pmid: 29886317
[8] Scarperi S., Pontrelli G., Campana C., Steinkasserer M., Ercoli A., Minelli L. et al.: “Laparoscopic radiofrequency thermal ablation for uterine adenomyosis”. JSLS, 2015, 19.
doi: 10.4293/JSLS.2015.00048 pmid: 26273186
[9] Fernandez H.: “New concepts on pathophysiology, diagnosis and treatment of adenomyosis”. J Gynecol Obstet Biol Reprod (Paris), 2003, 32, S23-27.
[10] Wood C.: “Surgical and medical treatment of adenomyosis”. Hum. Reprod., 1998, 4, 323-336.
doi: 10.1093/oxfordjournals.humrep.a136897 pmid: 2497136
[11] Berman J.M., Bolnick J.M., Pemueller R.R., Garza Leal J.G.: “Reproductive outcomes in women following radiofrequency volumetric thermal ablation of symptomatic fibroids. a retrospective case series analysis”. J Reprod Med, 2015, 60, 194-198.
pmid: 26126303
[12] Bing-Song Z., Jing Z., Zhi-Yu H., Chang-Tao X., Rui-Fang X., Xiu-Mei L. et al.: “Unplanned pregnancy after ultrasound-guided percutaneous microwave ablation of uterine fibroid.: A follow-up study”. Sci. Rep., 2016, 6, 18924.
doi: 10.1038/srep18924 pmid: 26733265
[13] Garza-Leal J.G., Toub D., León I.H., Saenz L.C., Uecker D., Munrow M., et al.: “Transcervical, intrauterine ultrasound-guided radiofrequency ablation of uterine fibroids with the vizablate system: Safety, tolerability, and ablation results in a closed abdomen setting”. Gynecol Surg., 2011, 8, 327-334.
doi: 10.1007/s10397-010-0655-3
[14] Kim C.H., Kim S.R., Lee H.A., Kim S.H., Chae H.D., Kang B.M.: “Transvaginal ultrasound-guided radiofrequency myolysis for uterine myomas”. Hum. Reprod., 2011, 26, 559-563.
doi: 10.1093/humrep/deq366
[15] Khan K.S., Wojdyla D., Say L., Gülmezoglu A.M., Van Look P.F.: “Who analysis of causes of maternal death: A systematic review”. The lancet, 2006, 367, 1066-1074.
doi: 10.1016/S0140-6736(06)68397-9
[16] Silverberg S.G., Kurman R.J., Gilbert-Barness E.: “Atlas of tumor pathology, 3rd series, fascicle 3: Tumors of the uterine corpus and gestational trophoblastic disease”. Arch. Pathol. Lab. Med., 1994, 118, 101.
[17] Ueda H., Togashi K., Konishi I., Kataoka M.L., Koyama T., Fujiwara T., et al.: “Unusual appearances of uterine leiomyomas: Mr imaging findings and their histopathologic backgrounds”. Radiographics, 1999, 19, S131-S145.
doi: 10.1148/radiographics.19.suppl_1.g99oc04s131 pmid: 10517450
[18] Tongsong T., Khunamornpong S., Sirikunalai P., Jatavan T.: “Adenomyosis in pregnancy mimicking morbidly adherent placenta”. BMJ Case Rep., 2014, bcr2013201509.
[19] Shitano F., Kido A., Fujimoto K., Umeoka S., Himoto Y., Kiguchi K. et al.: “Decidualized adenomyosis during pregnancy and post delivery: Three cases of magnetic resonance imaging findings”. Abdominal Imaging, 2013, 38, 851-857.
doi: 10.1007/s00261-013-9988-5
[20] Medel J.M., Mateo S.C., Conde C.R., Cabistany Esque A.C., Rios Mitchell M.J.: “Spontaneous uterine rupture caused by placenta percreta at 18 weeks' gestation after in vitro fertilization”. J OBSTET GYNAECOL RE, 2010, 36, 170-173.
[21] Miller D.A., Chollet J.A., Goodwin T.M.: “Clinical risk factors for placenta previa-placenta accreta”. Am. J. Obstet. Gynecol., 1997, 177, 210-214.
doi: 10.1016/s0002-9378(97)70463-0 pmid: 9240608
[22] Legro R.S., Price F.V., Hill L.M., Caritis S.N.: “Nonsurgical management of placenta percreta: A case report”. Obstet Gynecol., 1994, 83, 847-849.
pmid: 8159372
[23] Kayem G., Pannier E., Goffinet F., Grangé G., Cabrol D.: “Fertility after conservative treatment of placenta accreta”. Fertil Steril, 2002, 78, 637-638.
doi: 10.1016/S0015-0282(02)03292-2
[24] Wang L.M., Wang P.H., Chen C.L., Au H.K., Yen Y.K., Liu W.M.: “Uterine preservation in a woman with spontaneous uterine rupture secondary to placenta percreta on the posterior wall: A case report”. J Obstet Gynaecol Re, 2009, 35, 379-384.
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