Abstract
BackgroundPlacenta percreta is a severe form of placenta accreta in which the placenta penetrates the entire uterine wall and attaches to another organ such as the bladder and bowel. It gives rise to a major obstetric hemorrhage, peripartum hysterectomy, and maternal and fetal morbidity and mortality.Case presentationI present a 34-year-old female of 24 week gestation a case of placenta percreta with a history of bleeding per vagina for the last 1 month for that she received 11 units of blood transfusion. Placenta percreta with fetal demise was diagnosed in magnetic resonance imaging on admission. Uterine artery embolization was done to reduce perioperative bleeding. Hysterectomy was done successfully with the multidisciplinary team approach under general anesthesia.ConclusionsSo, proper preoperative planning and good communication with the multidisciplinary approach will make a better outcome in these types of cases.
Highlights
Placenta percreta is a severe form of placenta accreta in which the placenta penetrates the entire uterine wall and attaches to another organ such as the bladder and bowel
I present a case report of placenta percreta with fetal demise which was successfully managed with planned hysterectomy under general anesthesia
A large amount of clotted for 3 days, and she had complained of pain in the abdomen, high-colored urine, pruritus, and constipation for the last 20 days. She had a previous history of two lower segment cesarean sections (LSCSs)
Summary
Hemorrhage in obstetric patients is the most common cause of maternal morbidity and mortality (Say et al, 2014). I present a case report of placenta percreta with fetal demise which was successfully managed with planned hysterectomy under general anesthesia. Bladder separation causes major bleeding, and the total operative time was 3 h and 45 min. The trachea was extubated after adequate reversal from muscle relaxation She was shifted to the intensive care unit for vital monitoring. Intraoperative arterial blood gas analysis report was normal except the hemoglobin was 8.4gm%. Postoperative pain was managed with patient-controlled epidural analgesia with 0.125% bupivacaine and fentanyl 2 μgm/ml @5 ml/h with 5 ml demand dose and 15 min lockout interval for 72 h along with paracetamol 1 gm 8 hourly. The patient was discharged from the ward in a stable condition
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