Abstract
Introduction: Placenta percreta is the development of an abnormal invasive placentation which potentially could develop an obstetrical emergency condition for the mother and fetus. Previous uterine surgery, as caesarean section, is the most significant factor contributing to its etiopathogenesis. Clinical Case Presentation: The present report describes a case of a 27-year-old with an obstetrical history of six previous caesarean sections presented at our Emergency Department, complaining sudden uterine constriction during the 32nd week of pregnancy with an ultrasonographical diagnosis of central placenta previa. Intervention: An emergency caesarean section was performed, but the absence of the uterine myometrium layer and the placenta (directly implanted on the uterine dehiscent scar) required a subsequent hysterectomy. The patient was not strictly monitored during the pregnancy, irregardless of her high risk of prenatal and perinatal complications. Conclusion: When evaluating women with a history of multiple previous caesarean sections, it is mandatory to evaluate the occurrence of the possible complications in order to treat and prevent life-threatening conditions for the mother and the new-born.
Highlights
Placenta percreta is the development of an abnormal invasive placentation which potentially could develop an obstetrical emergency condition for the mother and fetus
When evaluating women with a history of multiple previous caesarean sections, it is mandatory to evaluate the occurrence of the possible complications in order to treat and prevent life-threatening conditions for the mother and the new-born
Many studies show that women with CS history have a higher risk of the following complications: haemorrhagic disorders, abnormal placentation, uterine rupture, stillbirth, and repeated caesarean sections [2]
Summary
Caesarean section (CS) is an effective procedure in preventing maternal and perinatal mortality and morbidity, it is not without risks and it has been associated with short- and long-term complications [1]. Many studies show that women with CS history have a higher risk of the following complications: haemorrhagic disorders, abnormal placentation, uterine rupture, stillbirth, and repeated caesarean sections [2]. Placental attachment disorders (PAD) clearly show the following documented risk factors: previous uterine surgical procedures, placenta previa, previous caesarean sections and maternal age [12]. The patient had previously performed eight uterine surgical procedures from 2004 to 2016, consisting of six previous caesarean sections, one of them complicated by preterm abruptio placentae, and two uterine dilations and curettage for two spontaneous abortions She has performed only two ultrasound examinations in the second trimester of pregnancy, where a condition of an abnormally low-lying placentation was detected, but no concerns about an abnormally attachment were made and no additional diagnostic examinations were performed. The pathologist confirmed the bladder mini-invasion by the placenta percreta, located in several areas
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