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Case Report

Liturgical ( not surgical ) removal of placenta: A case of spontaneous expulsion of placenta accreta.

Sharmeen Vazifdar, Urmila Gavali.

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The retained placenta is a significant cause of maternal mortality and morbidity throughout the developing world. It complicates 2% of all deliveries. This is a case of a 25-year female patient who came to our institute with retained placenta. The patient gave a history of delayed expulsion of the placenta after delivery in her previous pregnancy. Ultrasonography was performed which subsequently suggested placenta increta with the placenta being attached over a 5 cm surface of the endometrium. An informed decision for obstetric hysterectomy was made on the day of admission. The surgery was postponed by a day until the necessary financial arrangements could be made by the relatives. However, a few hours before the scheduled surgery, the patient started complaining of the painless passage of clots and on examination, the placenta was felt in the vagina after voluntary separation. Consequently, the patient delivered a bilobed placenta spontaneously. In our case, the placenta was delivered spontaneously within 48 hours of delivery without any external aid reinstating that in a case of retained placenta, with the due risk of infection, in the absence of per vaginal haemorrhage, spontaneous separation of the placenta could be awaited in low-risk cases.

Key words: retained placenta, placenta accreta, placenta increta, spontaneous expulsion

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