Successful conservative treatment of multiorgan infiltrating placenta percreta by uterine embolization and followup with serial magnetic resonance. A case report

Abstract

IntroductionConservative management was recently adopted as an option with an aim to reduce surgical complication and improve maternal outcome. We present a case of placenta percreta that invaded the urinary bladder, sigmoid colon, rectum, and vagina of a patient treated with conservative management successfully.The work has been reported in line with the SCARE criteria (Agha et al., 2018 [1]). Case presentationA 32-year-old woman, gravida 4, para 3. She had previously had 3 caesarean sections. At 36 week of gestation patient referred to our centre with a diagnosis of placenta praevia with a high suspicion of placenta percreta. Ultrasound and MRI repeated and confirmed the diagnosis with invasion to the rectum/sigmoid colon, urinary bladder, and upper vagina. Patient treated successfully by uterine embolization and follow up without any complication and we performed serial MRI to evaluate the course of conservative management. DiscussionPlacenta percreta is a serious condition with high maternal morbidity and mortality rate. Cesarean hysterectomy is the standard treatment for now. However, conservative management was recently adopted as an option. Many case reports were published with placenta percreta that invaded the urinary bladder and treated conservatively but this is a placenta percreta that invaded the urinary bladder, sigmoid colon, rectum, and vagina. We opted conservative management and performed serial MRI to evaluate the course of conservative management. ConclusionWe believe that this case is the first case of placenta percreta that invaded the urinary bladder, sigmoid colon, rectum, and vagina. That treated successfully by conservative management and publishing this case will improve the clinical information about the course of the conservative management of placenta percreta.