Abstract
A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation; she was treated with red cell concentrate and fresh frozen plasma transfusion. She was admitted to our hospital at the 11th week of gestation for continuous genital hemorrhage and cervical shortening (20 mm). Ultrasonography revealed placenta previa totalis. A lowlying gestational sac in early pregnancy, vascular lacunae, and an obscured retroplacental sonolucent zone indicated placenta percreta; magnetic resonance imaging showed similar findings. Owing to placenta percreta, uterus preservation was considered impossible. Elective cesarean section followed by total hysterectomy was performed at the 37th week of gestation, with bilateral internal iliac artery balloon catheter occlusion for reducing blood loss. The perioperative blood loss was 2,835 mL, for which the patient received blood transfusion. The postoperative course was uncomplicated.
Highlights
The treatment of placenta percreta is one of the most difficult procedures in perinatal medicine because of the risk of intraoperative massive hemorrhage
A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation; she was treated with red cell concentrate and fresh frozen plasma transfusion
Etiological factors for placenta accreta, increta, and percreta include the occurrence of placenta previa, previous delivery by cesarean section, previous curettage(s), and multigravidity [3]
Summary
The treatment of placenta percreta is one of the most difficult procedures in perinatal medicine because of the risk of intraoperative massive hemorrhage. Abnormal placental adherence occurs after defective decidual for-. *Disclosure: The authors have no conflicts of interest. The placenta remains unusually adherent to the implantation site, with scanty or absent deciduas, due to the fact that the physiological line of cleavage through the decidual spongy layer is lacking. We report our experience of cesarean hysterectomy using bilateral internal iliac artery balloon catheter occlusion in a patient with placenta previa percreta, avoiding catastrophic hemorrhage and leading to good clinical outcome
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