Antenatally Ultrasound-impressed Placenta Percreta Complicated with Massive Hemorrhage Despite a Combinational Arterial Embolization and Two-stage Surgery

Abstract

Morbidly adhered placentas include the spectrum of accreta, increta, and percreta. Abnormal placentation carries a significant risk of hemorrhage when late in gestation especially at peripartum. Many measures including extirpative surgery, selective arterial embolization, and methotrexate have been proposed either as a single method or in combination in the literature. We report a woman with placenta percreta who suffered from massive hemorrhage despite being treated with two-stage surgery plus intervening prophylactic uterine artery embolization. Classical incision at cesareans followed by selective uterine artery embolization and delayed hysterectomy still resulted in a failure to control bleeding. The patient survived after prolonged surgery and hospitalization in the intensive care unit. Treatment of placenta percreta needs to be considered on an individual basis and carries a significant risk of morbidity.