The delivery was by a C.S. and the placenta was complete centralis, the
uterine incision was almost above it. So,complete removal was ensured and no
retained part of that size, or even lesser, was left. However, As I said the
placenta was adherent to the lower segment (accreta) and possibly "minute"
pieces that were attached to the uterine wall were left and they are the
initiators of this large mass of granulation tissue!
--
===================================================
>Sorry... Accessory lobe OR something.
>
>Or how about a myoma?
>
>Joe P.
No, I'm sure that this is not an accessory lobe. The uterus has been
inspected and searched carefully both its upper and lower segments. Also no
myomas were encountered at all either in antenatal U/S or during the
operation.
===================================================
>"The mass is 10X66X85 mm." - it looks like an hematoma of the uterine scar?
>More so if you replaced the bladder flap --
This is another possibility that is kept in mind but its position in U/S is
somewhat strange for a hematoma! You can revise the U/S image and see the
position of the mass in relation to the both the body of the
uterus, cervix, and bladder (I'm reattaching another illustrated image).
===================================================
>also - if you have any prenatal ultrasounds to post of the placental
>location, this would also be helpful. thanks.
>
>art
OK, I'll ask the patient to provide me with her antenatal U/S, scan a good
image and post it. I only keep the report on my computer with no images!
==================================================
>Interesting case. With a previa following two cesareans, the main
>concern is placenta accreta. Perhaps the heavy blood loss at delivery
>was indicative of a defective decidua basalis and abnormal placentation.
>Although I was unable to access the photos, comments made by the other
>respondants suggest what I suspect - a hematoma, perhaps within the
>myometrium. Given the size of the mass and continued heavy bleeding in
>addition to multiparity, hysterectomy would seem expedient and curative.
>In any event,I would anticipate continued bleeding. Additional imaging
>may be useful only in determining whether the mass is expanding or
>contracting, but expectant management would appear to be insufficient.
>
>--
>M.A. Pelosi, III, MD
Yes, it was an accreta as I said earlier but the blood loss now is not
"heavy", it gets on and off with passage of a large (dark) clot at a time,
that seems to be from the mass itself hence the decision to conserve and
wait and see. I hate to hear the word hysterectomy in this particular case
as there was no lower segment as the one we all know! Only a very thin sheet
of muscle almost inseparable from the bladder! Total hysterectomy here would
require a miracle to dissect the bladder and get below the cervix/mass to
remove it totally especially after what this mass may have done in the
pelvis!
==================================================
Thanks for all your inputs and I'll keep you updated.
Abdelhamid
Dr. Abdelhamid Attia, MD
Assist. Prof. of Ob&Gyn - Cairo University
Http://www.geocities.com/thetropics/7210/
