@ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA
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Global Jou nal o Resea ch in Medical Sciences
ISSN: 2583-3960 (Online)
Volume 05 | Issue 06 | No .-Dec. | 2025
Jou nal homepage: h ps://gj publica ion.com/gj ms/
Case Repo
Placen omegaly in P egnancy wi h P ima y Pos pa um Haemo hage leading o Caesa ean
Hys e ec omy: A Case Repo o a P e en ed Fe o -Ma e nal Dea h in a Te ia y Hospi al in
Aku e
Bamidele Jimoh Fola in 1, *The esa Azonima I inyenikan 1, Oluwaleke Tolaniawo Ogunleye 2, Alexande Iyangbeso 1,
Adesina Law ence Akin an 1
1Depa men o Obs e ics and Gynaecology, Uni e si y o Medical Sciences Teaching Hospi al, Aku e, Ondo S a e,
Nige ia.
2Depa men o Anaes hesia, Uni e si y o Medical Sciences Teaching Hospi al, Aku e, Ondo S a e, Nige ia.
*Co esponding au ho : The esa Azonima I inyenikan
Depa men o Obs e ics and Gynaecology, Uni e si y o Medical Sciences Teaching Hospi al, Aku e, Ondo S a e,
Nige ia.
INTRODUCTION:
Placen omegaly is an enla ged placen a which means i ’s hicke o weighs mo e han no mal. I can be caused by
condi ions like ma e nal anaemia, in ec ions, hyd ops e alis (Rhesus iso-immuniza ion), mac osomia, o mul iple
ges a ion [1]. While some imes, i ’s a sign o a high isk p egnancy, in many cases i is simply an o e sized placen a ha
may no cause mo e complica ion han a no mal one. I can also be an indica o o mo e se ious complica ions like pa ial
mola p egnancy, in asi e mole (Cho ioadenoma des uens) and placen a si e ophoblas ic umou (PSTT) [2]. The
des uc i e ype (in asi e mole) pene a es he u e ine wall and can lead o u e ine up u e and haemo hage. The e al
complica ions include in a-u e ine g ow h es ic ion (IUGR) [1] and e al demise.
The placen a weighs abou 500-600g which is abou 1/5 h -1/6 h o a no mal e us ha weighs be ween 2500 -3500g a
e m [3, 4]. When he placen a is abno mally la ge such as in ma e nal diabe es melli us, i is combined wi h newly
o med essels and inc eased su ace a ea as a compensa o y mechanism [5]. In PSTT and in asi e mole, i can esul in
uncon ollable PPH due o u e ine a ony [2]. The ea men o p ima y PPH can be medical o su gical in e en ions. The
medical managemen include he use o oxy ocics such as oxy ocin, e gome ine o hea s able ca be ocin o he
p e en ion o PPH and he addi ional use o anexamic acid i PPH de elops [ 6]. While he su gical in e en ion
includes he use o u e ine ballon amponade, B Lynch b ace su u es, u e ine a e y liga ion and hys e ec omy [6].
Abs ac
Placen omegaly is an impo an ul asound inding in p egnancy. I may be asymp oma ic o some imes cause li e
h ea ening complica ions han a no mal sized placen a and could also se e as a clue o poo e o-ma e nal
ou come. We epo a 29-yea -old G2P1+0 (1 Ali e) now P2+0 (2 Ali e) wi h one p e ious caesa ean sec ion and
an ul asound diagnosis o placen omegaly a a ges a ional age o 35weeks+4days who had a epea caesa ean
sec ion a a ges a ional age o 35weeks+ 5days on accoun o educed e al mo emen s. She was deli e ed o a li e
male 2.6 kg neona e wi h APGAR sco e o 8 a one minu e and 9 a 5 minu es o li e and placen a weigh o 1.6 kg.
Mo he had p ima y pos pa um haemo hage (PPH) seconda y o u e ine a ony. She subsequen ly had a
caesa ean hys e ec omy due o p o ac ed bleeding and ailu e o all o he in e en ions o s op he bleeding wi h a
high index o suspicion o a ges a ional ophoblas ic disease especially an in asi e mole as he cause o he
bleeding. The u e ine and placen a issue we e sen o his ology which con i med in asi e(des uc i e) mole
(cho ioadenoma des uens). Ma e nal and pe ina al mo ali ies we e p e en ed ollowing p omp in e en ion and
a high index o suspicion.
Keywo ds: Placen omegaly, P ima y PPH, Caesa ean Hys e ec omy, Success ul Fe o-Ma e nal Ou come.
Global J Res Med Sci. 2025; 5(6), 11-14
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CASE REPORT:
This was a case o a booked 29- yea - old G2P1(1 Ali e) wi h 1 p e ious Caesa ean sec ion who was unsu e o he las
mens ual pe iod (LMP). She was admi ed om he an ena al clinic (ANC) on he 8 h o Sep embe 2025 wi h an
ul asound scan done ou side ou acili y which e ealed a single on li e e us wi h placen omegaly a 35weeks and 4
days.
The es ima ed e al weigh (EFW) was 2.9kg. The placen a was an e io ly si ed and enla ged in size measu ing 9.59cm
(No mal < 4cm) as shown in Figu e 1. He blood g oup was AB hesus D + e, e o i al sc eening (RVS), hepa i is B
su ace an igen (HBsAg), and HCV esul s we e non- eac i e. U inalysis was nega i e o glucose and p o ein, he
geno ype was AA and he packed cell olume was 39%. A epea ul asound scan was done in he An ena al wa d which
also e ealed a single iable e us a 35weeks+ 2 days. The EFW was 2.6kg, amnio ic luid index (AFI) was 20.9 cm.
The e was a la ge placen a wi h mul iple a eas o calci ica ions as shown in Figu e 2. On he basis o he placen omegaly
which was con i med om he second opinion ul asound scan; Fas ing blood suga and 2hou s pos -pand ial was
o de ed and esul s we e 3.3mmol/L and 4.7mmol/L espec i ely (No mal). Se um B human cho ionic gonado ophin (B-
HCG) was also o de ed and he esul was no mal. The pa ien could no a o d he cos o human placen a lac ogen
(HPL) because i was expensi e. The pa ien was subsequen ly counselled on elec i e Caesa ean sec ion (ELCS) which
she consen ed. Two uni s o blood was hen g ouped and c oss-ma ched o he .
On examina ion, he gene al clinical condi ion was sa is ac o y. She was no pale, he pulse a e was 82 bpm and he
blood p essu e was 100/80mmHg. On abdominal examina ion, he symphysio- undal heigh was 35cm, non- ende , e al
hea was hea d and egula . She was complian wi h he ou ine an ena al d ugs and was moni o ed closely on he wa d.
She howe e complained o educed pe cep ion o ma e nal e al mo emen s he nex day and she had eme gency
caesa ean sec ion (EMCS) on he 9 h o Sep embe 2025 wi h he deli e y o a li e male 2.6kg neona e wi h APGAR
sco e o 8 a one minu e and 8 a 5 minu es o li e. O he in a-ope a i e indings included a massi e placen a which
weighed 1.6kg which was mo e han hal o he baby as shown in Figu e 3. The e was no in a-ope a i e(pa um)
bleeding as haemos asis was secu ed as seen in Fig 4 a e u e ine closu e and in a enous hea s able ca be ocin 100ucg
was ins an ly adminis e ed a e deli e y o he baby. Howe e , he e was o en ial bleeding om he ex e nal ce ical
os du ing ul a oile ing and 1g o in a enous anexamic acid was gi en immedia ely and in a enous oxy ocin 40uni s
in 500mls o no mal saline was pu up. Also, 800mic og am o misop os ol was inse ed in o he ec um. The bleeding
howe e pe sis ed and in a enous anexamic acid 500mg was epea ed a e 30minu es bu o no a ail. Then, condom
ca he e was a emp ed bu he o en ial bleeding lushed i ou o he endome ial ca i y as seen in Fig 5. The es ima ed
blood loss (EBL) was 1.5L. A his s age we quickly eques ed o mo e uni s o esh whole blood and one uni o esh
ozen plasma (FFP). Two consul an Obs e icians quickly eso ed o e-lapa o omy and bimanual u e ine comp ession
in p epa a ion o B-Lynch su u e bu was abo i e (Figu e 5). The pa ien e en ually had o al Caesa ean hys e ec omy
wi h bila e al salpingo-oopho ec omy. The EBL o he second p ocedu e was 1.5L and he o al blood loss (TBL) was
3L. She had 6 uni s o blood and one FFP. She was counselled on in a-ope a i e indings and he ex en o he su ge y.
The pos -ope a i e PCV was 26%. She was discha ged home on haema inics on he 14 h o Sep embe 2025 in s able
condi ion. The u e us and i s appendages and he placen a issue we e sen o his ology and bo h e ealed
in asi e(des uc i e) mole (cho ioadenoma des uens). The pa ien was adequa ely counselled on he his ology epo and
subsequen ly e e ed o he Oncologis o u he expe managemen .
Global J Res Med Sci. 2025; 5(6), 11-14
@ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA
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Fig 1 Fig 2
Fig 3 Fig 4
Fig 5 Fig 6
Global J Res Med Sci. 2025; 5(6), 11-14
@ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA
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DISCUSSION:
We p esen ed a booked 29-yea -old G2P1 now P2+0 (2 Ali e) woman who was managed o p ima y pos pa um
haemo hage seconda y o u e ine a ony which occu ed ollowing placen omegaly which was diagnosed in he an ena al
pe iod a a ges a ional age o 35 weeks. The an ena al and pos pa um e o-ma e nal complica ions we e an icipa ed and a
epea obs e ic scan was done as depic ed in he diag am (Fig 6). The e us was comp essed o one side by he la ge
placen a wi h inc eased isk o e al comp omise/demise. The e we e also mul iple a eas o calci ica ions on he placen a.
This could be a sign o p egnancy ailu e wi h a sign o imminen e al loss in he absence o a imely in e en ion [7].
The pa ien was scheduled o elec i e Caesa ean sec ion and while on admission, she complained o educed e al
mo emen s he nex day his was con i ma o y and she had EMCS a 35weeks +5 days wi h he deli e y o a no mal
bi h weigh neona e wi h good APGAR sco e.
The pa ien had p ima y PPH and inally had o al Caesa ean hys e ec omy wi h bila e al salpingo-oopho ec omy. This
ea men is he gold s anda d o ophoblas ic umou and he eby limi he need o mul iple cou ses o chemo he apy
[8]. The decision was p omp ly aken by 2 consul an Obs e icians bea ing in mind he isk o lea ing a ce ical s ump
behind which can cause pe sis en bleeding and e en cance ous g ow h [9]. Al hough, his is mo e echnically di icul in
he ace o massi e obs e ic haemo hage because o he inhe en complica ions such as u e e ic inju y and he es . I
was cou ageously and pains akingly done because o he p o use bleeding; we had ophoblas ic umo s as he i s
di e en ial on he lis o ou di e en ial diagnosis and among his is PSTT which is ela i ely esis an o chemo he apy
and p oduce human placen al lac ogen (HPL) [10]. The o he di e en ial diagnosis such as diabe es melli us and hesus
iso-immuniza ion we e al eady uled ou om he in es iga ions we o de ed o . The his ology epo con i med he
diagnosis we had in mind which was in asi e mole he e o e he s ess and he decision was wo hwhile.
The decision o deli e his baby a a ges a ional age o 35 weeks which was close o e m was imely and had
con ibu ed o he success ul e al ou come epo ed in his baby. Also, he ma e nal complica ions ha we an icipa ed
and he p omp in e en ion con ibu ed o he success ul ma e nal ou come.
CONCLUSION:
Placen omegaly may be an ea ly sign o ma e nal complica ions be o e clinical symp oms o o he ad e se ou comes
become appa en wa an ing enhanced p ena al, in apa um and pos pa um ollow up o po en ially a ec ed
p egnancies.
IMPLICATION OF THIS CASE REPORT
This condi ion is no jus heo e ical as seen in he ex s. I is eal and can occu in any en i onmen o se ings. Adequa e
p epa a ions and managemen plan should be pu in place o a e imminen e o-ma e nal complica ion. The mos senio
doc o s o obs e icians should ake cha ge a he han booking such o he junio colleagues o ope a e.
REFERENCES:
1. Pa een, Z., Tongson-Ignacio, J. E., & F ase , C. R. (2007). Placen al mesenchymal dysplasia. A chi es o
Pa hology & Labo a o y Medicine, 131, 7–12.
2. Edmond, D. K. (2007). In Dewhu s ’s ex book o obs e ics and gynaecology (pp. 117–119). Blackwell Publishing.
3. Sadle , T. W. (2001). Langman’s medical emb yology (8 h ed., p. 140). Lippinco Williams & Wilkins.
4. Okpe e, E. (2004). Clinical obs e ics (p. 284). Uni e si y o Benin P ess.
5. Be ceanu, C., Te ileanu, A. V., & O i e u, A. M. (2018). Mo phological and ul asound indings in he placen a o
diabe ic p egnancy. Romanian Jou nal o Mo phology and Emb yology, 59(1), 175–186.
6. Edmond, D. K. (2007). In Dewhu s ’s ex book o obs e ics and gynaecology (pp. 150–152). Blackwell Publishing.
7. Fola in, B. J., I inyenikan, T. A., & Akindeju, F. F. (2022). P e- e m placen a calci ica ion in a pa ien wi h majo
placen a p ae ia and lac a ion wi h success ul oe al ou come: A case epo . A ican Jou nal o Fe o-Ma e nal
Medicine, 1, 57–60.
8. Be ek, J. S. (2014). In Be ek and No ak’s gynaecology (14 h ed., p. 1597). Lippinco Williams & Wilkins.
9. A ulkuma an, S., Si anesa a nam, V., Cha e jee, A., & Kuma , P. (2004). Essen ials o obs e ics (2nd ed., p. 494).
Jaypee B o he s Medical Publishe s.
10. Be ek, J. S. (2014). In Be ek and No ak’s gynaecology (14 h ed., p. 1591). Lippinco Williams & Wilkins.
