Placenta percreta is the most severe and rarest form of placenta accreta, with the chorionic villi invading through the perimetrium. It occurs in 5-7% of women with placenta accreta1 but remains a rare occurrence in women with normal placenta.2 This condition is associated with significant maternal mortality rate of 10% due to excessive blood loss3 and morbidities associated with involvement of surrounding structures. This report outlines a case of placenta percreta with involvement of urinary bladder, as well as current evidence in diagnosing and managing it.
Case report
A 36-year-old woman, with a gravida of 5, para of 2 and 2 miscarriages, at 24 weeks of gestation, was transferred from Narrabri to John Hunter Hospital, with abdominal pain and per vaginal bleeding, on the background of two previous caesarean sections and placenta previa. The bleeding was described as bright red with dark clots. The patient also experienced cramping pain. She was initially …show more content…
Normal foetal growth and well-being were noted on arrival. Ultrasound at 33 weeks initially revealed placenta accreta and previa. She was scheduled to have a caesarean section and a total abdominal hysterectomy at 37 weeks. Further ultrasound revealed an anterior placenta which prompted an investigation with MRI of the in-utero foetus and placenta, which revealed placental percreta with invasion of the anterior aspect of the urinary bladder. The urology and gynaecology-oncology surgical teams were involved in the surgery. A sample of uterus with placenta was sent for histopathological analysis and it was consistent with placental percreta. There was an estimated blood loss of 2000mL with 275mL returned to patient with cell saver. The baby was born with a birth weight of approximately 2700g and had an Apgar score of 7 at both 1 and 5 minutes. She then recovered uneventfully and was discharged one week
Case report
A 36-year-old woman, with a gravida of 5, para of 2 and 2 miscarriages, at 24 weeks of gestation, was transferred from Narrabri to John Hunter Hospital, with abdominal pain and per vaginal bleeding, on the background of two previous caesarean sections and placenta previa. The bleeding was described as bright red with dark clots. The patient also experienced cramping pain. She was initially …show more content…
Normal foetal growth and well-being were noted on arrival. Ultrasound at 33 weeks initially revealed placenta accreta and previa. She was scheduled to have a caesarean section and a total abdominal hysterectomy at 37 weeks. Further ultrasound revealed an anterior placenta which prompted an investigation with MRI of the in-utero foetus and placenta, which revealed placental percreta with invasion of the anterior aspect of the urinary bladder. The urology and gynaecology-oncology surgical teams were involved in the surgery. A sample of uterus with placenta was sent for histopathological analysis and it was consistent with placental percreta. There was an estimated blood loss of 2000mL with 275mL returned to patient with cell saver. The baby was born with a birth weight of approximately 2700g and had an Apgar score of 7 at both 1 and 5 minutes. She then recovered uneventfully and was discharged one week