(Schoolmeester and Bakkum-Gamez. (2020).

Retained Products of Conception After Cesarean

Section and Occult Placenta Accreta.95(11):2462-2463.
https://doi.org/10.1016/j.mayocp.2020.08.046)

Retained POC often is placental tissue that persists in the uterus after delivery or evacuation.
Abnormal placentation, such as placenta accreta, can increase risk of retained POC.

Clinically, placenta accreta often leads to combined cesarean section and hysterectomy secondary to
obvious placental attachment to the myometrium or hemorrhage after manually separating the
placenta from the underlying myometrium.

Occult accreta may not be clinically evident at the time of uncomplicated delivery but symptomatic
retained POC after accreta may require surgical intervention.

(Takeda, A., & Koike, W. (2017). Conservative endovascular management of retained placenta
accreta with marked vascularity after abortion or delivery. Archives of Gynecology and Obstetrics,
296(6), 1189–1198. doi:10.1007/s00404-017-4528-0)

Clinically, retained placenta accreta with marked vascularity presents a diagnostic and therapeutic
challenge, especially when uterine preservation is a major concern. Therefore, when a vascular
lesion is identified by color Doppler ultrasonography, further examinations by 3D-CTA can provide
more information for precisely evaluating the vascular mass and its feeding artery in abnormal
placentation.

TACE with dactinomycin was chosen for devascularization along with cytotoxic effects on active
trophoblasts; in contrast, if the serum β-hCG level was low (≤ 25 mIU/mL), TAE was chosen. After
confirming devascularization, the additional need for hysteroscopic resection and systemic
methotrexate administration was individually determined.

For characterizing the mass lesion in the postpartum uterus, MRI has a superior space-resolving
ability to delineate the soft tissue in detail using a variably enhancing intracavitary or intramuscular
signal with associated disruption of the uterine myometrial layers. In addition, intracavitary placental
lesions with their attachment site can clearly be visualized on MRI, helping to determine the need for
hysteroscopic resection after devascularization.

( Carusi, D. A. (2018). The Placenta Accreta Spectrum. Clinical Obstetrics and Gynecology, 1.
doi:10.1097/grf.0000000000000391 )

There is presumptive link between PAS to a previous history of retained placenta with manual
extraction or retained products of conception. Both conditions may indicate previous adherent
placentation, or damaged decidua from the procedures required to treat them.