Multidisciplinary Management of Placenta Accreta Avoiding Maternal Mortality in a High-Risk Center- Case Report

Abstract

Background: Placenta Accreta (PA) constitute a spectrum of abnormal placentation associated with a significant increase in maternal morbidity and mortality. Antenatal diagnosis of PA has transcendental importance in the orientation of the multidisciplinary management showing a substantial reduction in hemorrhagic complications. Case Presentation: A patient of 36.4 weeks of gestation with ultrasound findings of placenta previa and a high probability of placenta increta was attended in our high-risk center. Cesarean section with hysterectomy was performed at 37 weeks. During the surgical procedure, it was found infiltration of the placenta up to the uterine serosa at the level of the uterine segment and adjacent bladder. A hysterotomy at the corpus of the uterus was performed and a healthy newborn was obtained. Ligation of the hypogastric arteries bilaterally and total abdominal hysterectomy was achieved. The patient received a transfusion of red blood cells, platelets, cryoprecipitates and fresh frozen plasma and required vasopressor support with favorable evolution and avoiding fetal and maternal complications. The review of this case highlights that the management by a multidisciplinary team reduces the complications and morbidity-mortality of patients with placenta accreta as it is currently a public health problem. Conclusions: The maternal-perinatal outcomes not only depend on the availability of prenatal diagnosis but also on the organization of this multidisciplinary group with the application of standardized management and providing care in high-risk centers.