Interval Hysterectomy for Placenta Percreta – a Case Report

Mohammad Sazzadul Huque, Mini Ravi

Abstract


Introduction: Placenta percreta is an abnormality of placentation where it invades the serosa and can go beyond it. Complications include massive hemorrhage, bladder dysfunction, and severe infections during delivery.  The aim of this study is to report a complex case of placenta percreta managed by interval hysterectomy.

Case presentation: Pre-operative: 34 years old patient with previous three cesarean sections was followed in antenatal clinic. She came with repeated bouts of vaginal bleeding at 30-31 weeks. At 32 weeks and 4 days classical cesarean section was done with placenta left in situ. Prophylactic bilateral internal iliac artery balloon was inserted. Post cesarean section, uterine artery embolization was performed. Post-operative: Clinical features of pulmonary embolism (PE) developed about 4 hours later. Post-Operative Day 13: Total abdominal hysterectomy was done. After few days of discharge, the patient presented to the emergency department with shortness of breath. She was consequently diagnosed with chronic pulmonary embolism and treated with warfarin.

Conclusion: This is a case of placenta percreta managed by interval hysterectomy. However, the most widely accepted method of management is cesarean hysterectomy. In this case, interval hysterectomy was done due to the possibility of bladder invasion by placenta, to decrease the amount of blood loss and to reduce the number of days stayed in hospital. Appropriate management for the patient must be personalized, whether it is by cesarean hysterectomy or interval hysterectomy,  as each has risks and benefits.


Keywords


Placenta Percreta; Interval Hysterectomy; Case Report; Complications of Placenta Percreta

Full Text:

PDF

References


Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and Risk Factors for Placenta Accreta/Increta/Percreta in the UK: A National Case-Control Study. PLoS One. 2012;7(12):e52893.

Ibrahim MA, Liu A, Dalpiaz A, Schwamb R, Warren K, Khan SA. Urological Manifestations of Placenta Percreta. Curr Urol. 2015;8(2):57-65.

Hudon L, Belfort MA, Broome DR. Diagnosis and management of placenta percreta: a review. Obstet Gynecol Surv. 1998;53:509–517.

Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am. J. Obstet. Gynecol. 2005;192(5):1458–1461.

Price FV, Resnik E, Heller KA, Christopherson WA. Placenta previa percreta involving the urinary bladder: a report of two cases and review of the literature. Obstet Gynecol. 1991;78:508-511.

Placenta Accreta Spectrum. Obstetric Care Consensus. 2018;132(6):259-17. Available from: https://www.acog.org/-/media/Obstetric-Care-Consensus-Series/occ007.pdf?dmc=1&ts=20181129T1453250701. Accessed on January 28, 2019.

Farquhar CM, Li Z, Lensen S et al. Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case–control study. BMJ Open. 2017;7(10):e017713.

Rajkumar B, Kumar N, Sowmya S. Placenta percreta in primigravida, an unsuspected situation. Int Jour of Reprod, Contracept, Obs & Gyn [Internet]. 2014;3(1). Available from: http://www.ijrcog.org/index.php/ijrcog/article/view/830. Accessed on January 28, 2019.

Wright JD, Pri-Paz S, Herzog TJ. Predictors of massive blood loss in women with placenta accreta. Am. J. Obstet. Gynecol. 2011;205(38):1-6.

Sentilhes. Maternal outcome after conservative treatment of placenta accreta. Obstet. Gynecol. 2010;115(3):526–534.

Konijeti R, Rajfer J, Askari A. Placenta Percreta and the Urologist. Rev Urol. 2009;11(3):173–176.

Fay EE, Norquist B, Jolley J, Hardesty M. Conservative Management of Invasive Placentation: Two Cases with Different Surgical Approaches. AJP Rep. 2016;6(2):212–215.

Wong VV1, Burke G. Planned conservative management of placenta percreta. J Obstet Gynaecol. 2012;32(5):447-52.

Emily W, Stephanie C, Noelle B, Yongmei H, William B, Annette P. Surgical Management of Placenta Percreta: Outcomes of Immediate Versus Interval Hysterectomy. Obstetrics & Gynecology. 2018;131(117S). Available from: https://journals.lww.com/greenjournal/Abstract/2018/05001/Surgical_Management_of_Placenta_Percreta__.406.aspx. Accessed on January 28, 2019.




DOI: https://doi.org/10.5195/cajgh.2019.345

Refbacks

  • There are currently no refbacks.




Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.