Operative management of placenta percreta: a case report

Introduction Successful conservative and operative treatments have been suggested for an abnormally invasive placenta. However, high morbidity and mortality up to 7% are reported.

Case A 41-year-old woman with prior cesarean section and three abortions first presented at 32 weeks´ gestation showing obvious sonographic features of abnormally invasive placenta. Lung maturation followed at 33 weeks and the operation with prior placement of ureteric stents and iliacal balloon catheter was scheduled at 35 weeks. Intraoperative placenta percreta was confirmed. A cesarean hysterectomy with right adnexectomy and partial cystectomy due to involvement was performed after neonatal delivery. A right-sided ureteric lesion was sutured, blood loss (2500ml) was corrected by autologous transfusion of 500ml and clotting factors. The patient was discharged at 6^th postoperative day in good condition.

Discussion Despite a well-organized interdisciplinary approach in this case of an unusually infiltrating placenta percreta morbidity remainded significant, but our patient recovered well. Prenatal diagnosis and an interdisciplinary approach are very important to reduce adverse outcomes. Treatment strategies are discussed.

Conclusion Given the completed family planning we believe a cesarean hysterectomy was the best option of care in this case. Nevertheless, therapeutic options must be tailored to the intraoperative finding and patients’ will.

Abb.1 Placenta percreta with bladder involvement.

Publication History

Article published online:
07 October 2020