Placenta percreta with bladder and rectum invasion

Cirugia y cirujanos
Froilán Tórrez-Morales, Jesús Carlos Briones-Garduño

Abstract

Placenta percreta may lead to massive obstetric haemorrhage, haemodynamic decompensation, and ultimately death. Total obstetric hysterectomy is universally accepted as treatment; however, the emergence of new techniques such as the uterine artery angioembolisation approach, and the use of chemotherapy agents such as methotrexate, are alternatives also described in the literature. A 28 year-old patient, in her fourth gestation, with a previous history of 2 vaginal and 1 caesarean birth 4, in her 28.4 week of pregnancy, by second trimester ultrasound, was diagnosed with placenta percreta with bladder and rectal invasion using magnetic resonance imaging. Multidisciplinary and sequential treatment included: Caesarean with placenta in situ, uterine artery embolisation immediately after caesarean, chemotherapy with methotrexate weekly for 4 doses, and finally obstetric hysterectomy after bilateral hypogastric artery ligation. The outcome was favourable and the patient was discharged in good general condition. The protocoled and sequential management including selective embolization immediately after caesarean section with placenta in situ, weekly chemotherapy with methotrexate and obstetric hysterectomy, preceded by bilateral ligatio...Continue Reading

References

Jan 1, 1986·Acta Obstetricia Et Gynecologica Scandinavica·S ArulkumaranS S Ratnam
Jul 1, 1993·American Journal of Obstetrics and Gynecology·Y N BakriJ Legarth
Dec 1, 1996·American Journal of Obstetrics and Gynecology·J M O'BrienE S Donaldson

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