Abstract
Placenta previa percreta is a serious pregnancy condition that may cause massive bleeding. Life-threatening hemorrhage is commonly managed via cesarean hysterectomy or vascular ligations in order to preserve fertility. We present a case of bilateral external iliac artery thrombosis after pelvic compression and uterine devascularization due to placenta previa percreta. The patient had cesarean section due to ultrasonography and magnetic resonance imaging-diagnosed placenta previa percreta, and stated that she preferred a conservative approach rather than hysterectomy in a case of massive bleeding. Spontaneous hemorrhage was recognized during the operation. Pelvic compression and bilateral uterine and internal iliac artery ligations were performed. The left external iliac artery was accidentally held and bonded as the left internal iliac artery, which was turned loose within a minute after distinguishing the vessels. Emergency angiography that was applied because of patient’s leg pain showed bilateral external iliac artery thrombosis. Angioplasty was performed by a cardiologist for bilateral occlusions. Placenta invasion abnormalities may be managed by pelvic compression or vascular ligations, which have their own serious complications that the surgeon must manage immediately.
Highlights
Placenta percreta is a serious condition which is managed via pelvic artery ligation, preventive embolization of specific arteries, placental retention, or cesarean hysterectomy[1]
We present a case of bilateral external iliac artery thrombosis after pelvic compression and uterine devascularization due to placenta previa percreta
Placental invasion abnormalities are managed via radical or staged cesarean hysterectomy, vascular ligations and balloon embolization, placental retention, complex compression hemostasis for which pelvic packing is combined with uterine balloon placement, and partial hysterectomy for focal placental invasions[3,4]
Summary
Placenta percreta is a serious condition which is managed via pelvic artery ligation, preventive embolization of specific arteries, placental retention, or cesarean hysterectomy[1]. Pelvic packing may be considered to support either artery ligation or hysterectomy to reduce an uncontrolled hemorrhage[2]. We present a case of bilateral external iliac artery thrombosis following ligation of the bilateral hypogastric arteries and a transiently tied left external iliac artery, which underwent immediate angiography and thrombolysis
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