Abstract
Introduction and importancePlacenta accreta spectrum (PAS) is a state of abnormal attachment of the placenta, including placenta accreta, placenta increta, and placenta percreta. This condition can be life-threatening due to the placenta cannot spontaneously separated, resulting in continuous bleeding. Cesarean section followed by hysterectomy is one of the treatment options for PAS. There was a great liability for urinary tract injuries during the operation of PAS patient.Case presentationWe present the case of ureter injury during subtotal hysterectomy in patient with PAS. A 30-years-old female patient was diagnosed with recurrent antepartum hemorrhage due to placenta previa accreta spectrum on G2P1 33 weeks of gestational age, singleton live breech presentation, previous c-section 1×. After uterine transverse incision, the baby was delivered. We decided to perform subtotal hysterectomy. There was severe adhesion. On the exploration after subtotal hysterectomy was performed, we found ruptured of the right ureter.Clinical discussionHysterectomy peripartum is one of the treatment of PAS, either to prevent or to control postpartum hemorrhage. In pregnant women with morbid placental adherence, there was a great liability for urinary tract injuries. Distal ureters are the most commonly injured while hysterectomy. Injuries to the ureters in this patient occurred due to severe adhesions and unclear visual organ.ConclusionAlthough it is rare, ureter injury may occur during subtotal hysterectomy in patient with placenta accreta spectrum. To prevent that condition, inserting ureter stent can be perform before the operation. Multidisciplinary approach is carried out so that patient outcomes are good.
Highlights
Introduction and importancePlacenta accreta spectrum (PAS) is a state of abnormal attachment of the placenta, including placenta accreta, placenta increta, and placenta percreta
The incidence of PAS is placenta accreta 63%, placenta increta 15%, and placenta percreta 22% [2]. This condition can be life-threatening and usually necessitates hysterectomy due to the placenta cannot sponta neously separated resulting in continuous bleeding
Based on a multivariate analysis, placenta previa appeared to be an independent risk factors for PAS, while prior uterine surgery was not [6]
Summary
Placenta accreta spectrum is general term used to describe abnormal trophoblast invasion into the myometrium of the uterine wall that in cludes: placenta accreta, placenta increta, and placenta percreta [1]. The incidence of PAS is placenta accreta 63%, placenta increta 15%, and placenta percreta 22% [2]. This condition can be life-threatening and usually necessitates hysterectomy due to the placenta cannot sponta neously separated resulting in continuous bleeding. This case report has been reported in line with the SCARE 2020 guideline [3]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
