Management of placenta percreta – case report and clinic experience

Abstract

The incidence of placenta percreta is currently increasing. The treatment strategies are not clearly defined as there are a lot of inconsistencies in the literature regarding severity criteria. This pathology has a high risk for massive hemorrhage, therefore it is very challenging to agree on a standardized management. The therapeutic approaches include expectant management with placenta left in situ, conservative management and radical treatment. Cesarean hysterectomy currently represents the approach of choice for this condition, ideally performed by a multidisciplinary team. Conservative alternatives have been proposed to reduce maternal morbidity and maintain future fertility. The expectant management has benefits on reducing uterine perfusion and blood loss, useful in case of bladder or parametrial invasion. Potential late complications of placenta percreta left in situ often require further emergency surgery. Delayed hysterectomy has the aim to overcome these difficulties, but the reported outcomes are still contradictory. For these reasons, the most recent recommendation is not to perform a second elective surgery in a hemodynamically stable patient. In this paper we present the late complications of a case treated by expectative approach and the overall management in our clinic for the last five years with placenta accreta spectrum disorders.