English

Abstract

Retained placenta postdelivery should raise suspicion of adherent placenta. In such cases immediate decision and quick action can be life saving. Placenta percreta can at times present in second trimester with ruptured uterus. Placenta percreta is an obstetric emergency often associated with massive hemorrhage leading to emergency hysterectomy. We describe a severe case of placenta percreta in which the placenta was left in situ, methotrexate administered and a delayed hysterectomy successfully performed. Delayed hysterectomy may be a reasonable management strategy in the most severe cases. INTRODUCTION: A morbidly adherent placenta includes placenta accreta, increta or percreta. All together constitute approximately 1 in 2, 500 pregnancies. Placenta percreta is a rare, life threatening complication of pregnancy.1 In placenta percreta, the chorionic villi invade deeply up to the serosa and may even attach to surrounding organs such as urinary bladder and bowel. It constitutes about 5 % of all cases of adherent placenta. Maternal morbidity and mortality associated with Placenta accreta is mainly caused by massive obstetric hemorrhage or emergency hysterectomy, and placenta accreta is often diagnosed during delivery or immediately post-partum leading to an obstetric emergency. Studies suggest that antenatal diagnosis may reduce obstetric hemorrhage-related morbidity. Furthermore, in some cases a morbidly adherent Placenta accreta can be left in situ. Such conservative management may allow delayed removal of the placenta to avoid massive hemorrhage during an attempted forced removal of the adherent placenta. We present a rare case of placenta percreta with uterine anomaly in second trimester of pregnancy treated conservatively initially followed with emergency laparotomy.