{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T09:37:21Z","timestamp":1787391441674,"version":"build-2736575974"},"reference-count":39,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Angular pregnancies are rare and difficult to diagnose. Evidence suggests they are associated with a higher risk of intrauterine growth restriction and abnormal third stage of labor due to a retained placenta. The lack of standardized AP diagnostic criteria impacts on their correct identification and makes the treatment of potential complications challenging. We present a case of the successful conservative surgical management of a retained placenta after a term AP also complicated by intrauterine growth restriction. Moreover, to identify the best evidence regarding AP diagnostic criteria and retained placenta therapeutic approaches, we have realized an expert literature review.<\/jats:p>","DOI":"10.3390\/diagnostics13233492","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T10:24:13Z","timestamp":1700562253000},"page":"3492","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Surgical Conservative Management of a Retained Placenta after Angular Pregnancy, a Case Report and Literature Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7194-0986","authenticated-orcid":false,"given":"Giovanna","family":"Bitonti","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Magna Graecia University, Viale Europa, 87100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Quaresima","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Magna Graecia University, Viale Europa, 87100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3669-4071","authenticated-orcid":false,"given":"Giampiero","family":"Russo","sequence":"additional","affiliation":[{"name":"Consultorio Familiare, Azienda Sanitaria Provinciale Cosenza, Centro Sanitario, Ponte Pietro Bucci, Arcavacata, 87036 Cosenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costantino","family":"Di Carlo","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, Via Pansini 5, 80127 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina","family":"Amendola","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Magna Graecia University, Viale Europa, 87100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosanna","family":"Mazzulla","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Azienda Ospedaliera di Cosenza SS Annunziata, Via Felice Migliori 1, 87100 Cosenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Venturella","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Magna Graecia University, Viale Europa, 87100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Morelli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Azienda Ospedaliera di Cosenza SS Annunziata, Via Felice Migliori 1, 87100 Cosenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1067\/j.cpradiol.2022.11.005","article-title":"Angular and Interstitial Ectopic Pregnancies: A Clarification of Terms and Literature Review","volume":"52","author":"Densley","year":"2023","journal-title":"Curr. Probl. Diagn. Radiol."},{"key":"ref_2","first-page":"105","article-title":"Angular pregnancy: A review of cases reported in the past 80 years","volume":"1","author":"Rankin","year":"2014","journal-title":"Gynecol. Cases Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"218","DOI":"10.4274\/tjod.42402","article-title":"Angular pregnancy","volume":"13","author":"Alanbay","year":"2016","journal-title":"Turk. J. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1007\/s40477-022-00668-1","article-title":"Diagnostic dilemma between angular and interstitial ectopic pregnancy: 3D ultrasound features","volume":"25","author":"Durand","year":"2022","journal-title":"J. Ultrasound."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.jogc.2017.03.105","article-title":"Angular Pregnancy, Interstitial Pregnancy, Caesarean Scar Pregnancy and Multidose Methotrexate","volume":"39","author":"Tulandi","year":"2017","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1056\/NEJMra1302417","article-title":"Diagnostic criteria for nonviable pregnancy early in the first trimester","volume":"369","author":"Doubilet","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/AOG.0000000000003595","article-title":"Refining Angular Pregnancy Diagnosis in the First Trimester: A Case Series of Expectant Management","volume":"135","author":"Bollig","year":"2020","journal-title":"Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40738-020-00077-0","article-title":"Differentiating pregnancies near the uterotubal junction [angular, cornual, and interstitial]: A review and recommendations","volume":"6","author":"Finlinson","year":"2020","journal-title":"Fertil. Res. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e00068","DOI":"10.1016\/j.crwh.2018.e00068","article-title":"Angular vs. interstitial pregnancy: A case report highlighting diagnostic nuances with stark management differences","volume":"19","author":"Marfori","year":"2018","journal-title":"Case Rep. Womens Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.tjog.2020.09.033","article-title":"Conservative management for adherent placenta after live birth in angular or interstitial pregnancies: A new entity \u201cangular placenta attachment\u201d","volume":"59","author":"Nakatsuka","year":"2020","journal-title":"Taiwan. J. Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1002\/uog.22134","article-title":"ISUOG Practice Guidelines: Diagnosis and management of small-for-gestational-age fetus and fetal growth restriction","volume":"56","author":"Lees","year":"2020","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1016\/S0002-9378(11)90788-1","article-title":"Dynamic ultrasonographic imaging of the third stage of labor: New perspectives into third-stage mechanisms","volume":"168","author":"Herman","year":"1993","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_13","first-page":"486","article-title":"Angular pregnancy associated with incarceration of the placenta during the third stage of labor","volume":"86","author":"Gibberd","year":"1936","journal-title":"Guy\u2019s Hosp. Rep."},{"key":"ref_14","first-page":"1648","article-title":"Two Cases of Angular Pregnancy: [Section of Obstetrics and Gyn\u00e6cology]","volume":"29","author":"Blaikley","year":"1936","journal-title":"Proc. R. Soc. Med."},{"key":"ref_15","first-page":"638","article-title":"Angular or tubo-uterine pregnancy","volume":"12","author":"Kanakadurgamba","year":"1962","journal-title":"J. Obstet. Gynaecol. India"},{"key":"ref_16","first-page":"153","article-title":"Hysterotomy for retained placenta in a term angular pregnancy. A case report","volume":"45","author":"Deckers","year":"2000","journal-title":"J. Reprod. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.3109\/00016349.2010.516354","article-title":"Hysterotomy for retained placenta with imminent uterine rupture in a preterm angular pregnancy","volume":"89","author":"Shekhar","year":"2010","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_18","first-page":"594140","article-title":"Hysterotomy for retained placenta in a septate uterus: A case report","volume":"2012","author":"Lee","year":"2012","journal-title":"Case Rep. Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.5455\/2320-1770.ijrcog20141251","article-title":"Retain womb in retained placenta: Hysterotomy for retained bilobed placenta in a preterm angular pregnancy","volume":"3","author":"Amin","year":"2014","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s00404-017-4579-2","article-title":"Failed manual removal of the placenta after vaginal delivery","volume":"297","author":"Collins","year":"2018","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_21","first-page":"1","article-title":"Hysterotomy for Placental Delivery after Angular Pregnancy: A Case Report","volume":"5","author":"Xavier","year":"2019","journal-title":"JSM Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2914","DOI":"10.18203\/2320-1770.ijrcog20212695","article-title":"Angular pregnancy: An under-recognised entity presenting with retained placenta","volume":"10","author":"Rajbhar","year":"2021","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"ref_23","unstructured":"Cunningham, F., Leveno, K.J., Bloom, S.L., Dashe, J.S., Hoffman, B.L., Casey, B.M., and Spong, C.Y. (2014). Williams Obstetrics, McGraw-Hill. [25th ed.]."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1007\/s00404-023-06951-8","article-title":"How to do a fetal cardiac scan","volume":"307","author":"Quaresima","year":"2023","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_25","first-page":"167","article-title":"Angular intrauterine pregnancy","volume":"58","author":"Jansen","year":"1981","journal-title":"Obstet. Gynecol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"ESHRE Working Group on Ectopic Pregnancy, Kirk, E., Ankum, P., Jakab, A., Le Clef, N., Ludwin, A., Small, R., Tellum, T., T\u00f6yli, M., and Van den Bosch, T. (2020). Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice. Hum. Reprod. Open, 2020, hoaa055.","DOI":"10.1093\/hropen\/hoaa055"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1002\/uog.15966","article-title":"Use of double decidual sac sign to confirm intrauterine pregnancy location prior to sonographic visualization of embryonic contents","volume":"49","author":"Richardson","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.jogc.2017.03.087","article-title":"Can the Presence of a Surrounding Endometrium Differentiate Eccentrically Located Intrauterine Pregnancy from Interstitial Ectopic Pregnancy?","volume":"39","author":"Grant","year":"2017","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"6619","DOI":"10.1007\/s00330-022-08786-4","article-title":"Using MRI to differentiate upper-lateral intracavitary pregnancy and interstitial pregnancy for the patients with pregnancies in the uterotubal junction during the first trimester","volume":"32","author":"Liu","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100471","DOI":"10.1016\/j.ajogmf.2021.100471","article-title":"Incidental diagnosis of a pancreatic adenocarcinoma in a woman affected by gestational diabetes mellitus: Case report and literature review","volume":"3","author":"Quaresima","year":"2021","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2408","DOI":"10.1080\/14767058.2018.1432588","article-title":"The association between Mullerian anomalies and IUGR: A meta-analysis","volume":"32","author":"Karami","year":"2019","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Favilli, A., Tosto, V., Ceccobelli, M., Parazzini, F., Franchi, M., Bini, V., and Gerli, S. (2021). Risk factors for non-adherent retained placenta after vaginal delivery: A systematic review. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-03721-9"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1111\/1471-0528.12752","article-title":"Retained placenta is associated with pre-eclampsia, stillbirth, giving birth to a small-for-gestational-age infant, and spontaneous preterm birth: A national register-based study","volume":"121","author":"Endler","year":"2014","journal-title":"BJOG"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1007\/s00404-021-06027-5","article-title":"Retained placenta and postpartum hemorrhage: Time is not everything","volume":"304","author":"Franke","year":"2021","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0301-2115(01)00592-9","article-title":"The retained placenta-new insights into an old problem","volume":"102","author":"Weeks","year":"2002","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1159\/000370001","article-title":"Dynamic Changes in the Myometrium during the Third Stage of Labor, Evaluated Using Two-Dimensional Ultrasound, in Women with Normal and Abnormal Third Stage of Labor and in Women with Obstetric Complications","volume":"80","author":"Patwardhan","year":"2015","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_37","unstructured":"National Collaborating Centre for Women\u2019s and Children\u2019s Health [UK] (2014). Intrapartum Care: Care of Healthy Women and Their Babies during Childbirth, National Institute for Health and Care Excellence [UK]."},{"key":"ref_38","unstructured":"(2009). WHO Guidelines for the Management of Postpartum Haemorrhage and Retained Placenta, World Health Organization."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Committee on Practice Bulletins-Obstetrics (2017). Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet. Gynecol., 130, e168\u2013e186.","DOI":"10.1097\/AOG.0000000000002351"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/23\/3492\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:26:01Z","timestamp":1760131561000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/23\/3492"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,21]]},"references-count":39,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["diagnostics13233492"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13233492","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,21]]}}}