Placenta percreta with urinary tract involvement: the case for a multidisciplinary approach

Area of Science:

• Obstetrics and Gynecology
• Urology
• Surgical Planning

Background:

• Placenta percreta (PP) is a rare, high-risk pregnancy complication, especially when the urinary tract is involved.
• Cesarean delivery and hysterectomy are often necessary, increasing the risk of urinary tract injury.
• Adequate preoperative planning is essential to mitigate these risks.

Purpose of the Study:

• To evaluate the impact of preoperative planning and multidisciplinary team involvement on reducing complications in placenta percreta cases.
• To assess the role of preoperative urologic assessment in managing urinary tract involvement during placenta percreta.

Main Methods:

• Retrospective review of urologic consultations for placenta percreta cases over one year.
• Analysis of maternal factors, surgical timing, blood loss, complications, and outcomes.
• Categorization of urologic assessment timing into preoperative and perioperative.

Main Results:

• Five placenta percreta cases were reviewed; 4 diagnosed prenatally (2 with MRI).
• All patients required cesarean delivery and hysterectomy with significant blood transfusion (median 12 U).
• Preoperative urologic assessment (2 patients) with ureteral catheter placement resulted in no urinary complications, unlike 3 patients with perioperative consultation who sustained bladder/ureteral injuries.

Conclusions:

• Placenta percreta with urinary tract involvement is technically challenging and high-risk.
• Preoperative urologic assessment, imaging, and planning, including ureteral catheter placement, correlate with fewer urinary complications.
• Multidisciplinary team collaboration and thorough preoperative planning are recommended for managing placenta percreta.