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Federación Mexicana de Ginecología y Obstetricia, A.C.

2021, Número 02

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Ginecol Obstet Mex 2021; 89 (02)


Acretismo placentario en embarazo gemelar. Reporte de un caso y revisión de la bibliografía

Norzagaray-Barreras CE, Oseguera-Torres LF, Guizar-Solorio AR, Cárdenas-Valdez JC

Idioma: Español
Referencias bibliográficas: 31
Paginas: 141-150
Archivo PDF: 418.19 Kb.


RESUMEN

Antecedentes: El principal factor de riesgo de acretismo placentario es la placenta previa, con antecedente de cesárea anterior. El embarazo gemelar se asocia con alta probabilidad de placenta previa. Los embarazos logrados con técnicas de reproducción asistida, sobre todo mediante fertilización in vitro, tienen mayor probabilidad de acretismo. La sensibilidad de la ecografía es de 91% y especificidad de 97% para el diagnóstico de acretismo placentario, y un poco menor en el embarazo gemelar.
Objetivo: Informar el primer caso de embarazo gemelar complicado con placenta acreta con desenlace exitoso y revisar la bibliografía mexicana.
Caso clínico: Paciente de 20 años, con embarazo gemelar bicorial y antecedente de dos cesáreas. La ecografía de las 36 semanas evidenció dos placentas: una de ellas anterior, con datos de placenta increta-percreta. Se decidió la histerectomía obstétrica y ambas placentas se dejaron in situ y se ligaron las dos arterias hipogástricas. El sangrado se estimó en 1200 mL y no se requirió hemotransfusión. La paciente se dio de alta del hospital al tercer día del posoperatorio, sin complicaciones. El reporte histopatológico fue: placenta increta.
Conclusiones: La elevada morbilidad relacionada con el embarazo gemelar y el acretismo placentario hace indispensable que el establecimiento del diagnóstico sea minucioso para que permita detectar la adhesión mórbida, sobre todo si existen factores de riesgo y poder interrumpir a tiempo el embarazo y evitar las complicaciones.


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