Cervico‐isthmic Pregnancy with Placenta Percreta Ending in a Livebirth

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EDITORIAL COMMENT: We accepted this case for publication not because of a morbid interest in placenta percreta, irrespective of whether the fetus is above the placenta or below it, as it usually is in cases of cervical pregnancy, but because this rare condition provides the most serious obstetric complication of all requiring massive resuscitation and expert surgery. We have commented before that when Caesarean section is performed in these cases it is wise to have a competent gynaecological oncologist scrubbed‐up assisting as he will rightly become the senior surgeon if the operation proves difficult. In the Editor's experience, it is probably wise to electively open the bladder to facilitate removal of the friable lower uterine segment and cervix in these women. As shown by this case, bilateral internal iliac ligation does not guarantee haemostasis ‐ blood coagulation failure often occurs during surgery in the more difficult cases and should be anticipated.Previous Editorial Comments on placenta praevia accreta/cervical pregnancy are: Woolcott RJ, Nicholl M, Gibson JS. A Case of Placenta Percreta Presenting in the First Trimester of Pregnancy. Aust NZ J Obstet Gynaecol 1987; 27:258. Altintas A, Ozgunen FT, Doran S, Doran F. Placenta Percreta Invading the Urinary Bladder. Aust NZJ Obstet Gynaecol 1991; 31:371. Sanders RR. Placenta Praevia Percreta Invading the Urinary Bladder. Aust NZ J Obstet Gynaecol 1992; 32:375. Author's response to editorial comment:We did have a gynaecological oncologist (Mr John Wittaker) assisting who performed the internal iliac artery ligation as well as 2 consultant anaesthetists (Drs E Hughes and G Crooks). The blood loss was phenomenal; we measured 14 litres of blood loss and estimated there was another 3 on the table and floor. We had planned for a significant degree of blood loss but the actual amount caught all of the team by surprise.We attempted to aspirate the vault haematoma as there were recurrent febrile episodes which did not respond rapidly to antibiotics in the postoperative period. We presumed the 2 × 2 cm collection was either a separate haematoma or inflammatory mass.