Uterine artery chemoembolization followed by hysteroscopic resection for management of retained placenta accreta with marked vascularity after evacuation of first-trimester miscarriage in angular pregnancy: A case report

• Published in: Case reports in women's health 2021, Vol.32, p.e00360-e00360
• Main Authors: Takeda, Akihiro, Koike, Wataru, Katayama, Takaaki
• Format: Report
• Language: English
• ISSN: 2214-9112
• DOI: 10.1016/j.crwh.2021.e00360

BACKGROUNDAngular pregnancy is a rare form of eccentric intrauterine gestation. To determine the management strategy, angular pregnancy should be differentiated from interstitial pregnancy and cornual pregnancy. CASEA 37-year-old woman (gravida 5, para 4) with no previous disease history was referred because of a retained placenta with hemorrhage 20 days following the manual vacuum aspiration of an intrauterine pregnancy performed after the diagnosis of miscarriage at 8 weeks of gestation. At the initial examination, a prominent vascular mass was identified in the left lateral portion of the uterus. The patient's serum β-human chorionic gonadotropin level was 1949 IU/L. Magnetic resonance imaging revealed an enlarged angular space occupied by a suspected retained placenta with expansion of the surrounding myometrium. Three-dimensional computerized tomography showed a prominent vascular mass with a feeding left uterine artery and draining thick left ovarian vein. The diagnosis consisted of retained placenta accreta with marked vascularity after evacuation of a miscarriage in a woman with angular pregnancy. Uterine artery chemoembolization was performed followed by the administration of a single dose of systemic methotrexate. Because the gestational mass persisted and spontaneous expulsion appeared to be unlikely, despite the gradual decline of serum β-human chorionic gonadotropin levels, hysteroscopic resection of the retained placenta was performed and the patient's subsequent recovery was uneventful.