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A large mass of granulation tissue following C.S.From: Dr. Abdelhamid Attia (aattia@ritsec3.com.eg)Fri Dec 1 11:26:11 2000
Dear Doctors of the group, I want to seek your opinions about the following: A pregnant lady in her thirties, third gravida, full term, with 2 living children and a history of previous 2 C.S., presented at my clinic with gestational diabetes and placenta praevia centralis (Grade III). After diabetes control, I performed a C.S. to her at 38 weeks and found the placenta to be adherent to the lower segment, however, complete removal was successful on the expense of loosing blood to which 4 units of blood maintained the patient's circulatory function normal. Postoperative period and puerperium went fine except for somewhat more blood loss than usual. 6 weeks after labour, she visited me for followup and on examination the uterus was found to be large, subinvoluted and bleeding was ++. U/S revealed normal sized empty upper uterine segment with the presence of a large heterogenous mass, with large blood vessels inside, at the lower uterine segment mainly towards the anterior uterine wall (site of scar). The mass is 10X66X85 mm. The cervix is normal sized and its canal is empty. The likely diagnosis was a disrupted scar with a large mass of granulation tissue. B-Subunit HCG assay excluded choriocarcinoma. I'm managing the case conservatively but bleeding, though minimal, is continuous. I'm enclosing here two JPGs of the ultrasound of the patient and will wait for your insights. Thanks in advance, Dr. Abdelhamid Attia, MD Assist. Prof. of Ob&Gyn - Cairo University Http://www.geocities.com/thetropics/7210/
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