Catastrophic Morbidly Adherent Posterior Placenta: Case Reports, Literature Review Current Through at Long Time Since Cases Registration

Abstract

There are analyzed the difficulties and accuracy of diagnosis, in conjunction to the moment technical opportunities at long interval after registration (2009, 2012) in two cases of posterior Morbidly Adherent Placenta/Placenta Accreta Spectrum (MAP/PAS), with deep myometrial invasion (grade 3B) and uterine serosa perforation (grade 3E), a contemporary serious disease generating severe maternal coagulation disorders, multiple organ failure and hemorrhagic shock up to death, after total hemostasis hysterectomy. Undiagnosed or suspicious second trimester posterior MAP/PAS, in low-lying placenta, morbid obesity (BMI>40), in an intact uterus, or in a scar uterus post cesarean delivery (CD) were followed by maternal death. In countries with low-to-middle income/ resources, and few centers of excellence, medical staff surgical qualities, and well trained interdisciplinary team must meet patients’ and their families trust and cooperation, and timely available life-saving resources for complex therapies in critical care cases, and hospital infrastructure to benefit from actual expanded knowledge and guidelines.