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04:08
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Placenta previa percreta with bladder invasion.
Sinisa Sijanović1, Mirjana Rubin, Zlatko Topolovec
1Department of Gynecology and Obstetrics, University Hospital Osijek, Croatia.
Summary
A pregnant woman with placenta previa experienced severe hemorrhage during delivery. Surgical interventions, including artery ligation and hysterectomy, were necessary to control bleeding and ensure maternal safety.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Placenta previa, a condition where the placenta covers the cervix, poses significant risks during pregnancy and delivery.
- Previous cesarean sections increase the likelihood of placenta previa and associated complications like placenta accreta spectrum.
Observation:
- A 43-year-old woman at 32 weeks gestation presented with massive vaginal hemorrhage due to diagnosed placenta previa.
- The patient had a history of ten deliveries and two prior cesarean sections.
Findings:
- Emergency cesarean delivery was performed, complicated by uncontrollable hemorrhage upon manual placental removal.
- Placental invasion into the bladder wall was suspected, necessitating bilateral anterior internal iliac artery ligation.
- Supracervical hysterectomy was ultimately required to manage persistent, life-threatening bleeding.
Implications:
- This case highlights the critical management challenges of placenta previa with suspected placenta accreta spectrum.
- Aggressive surgical strategies, including pelvic artery ligation and hysterectomy, may be essential for hemorrhage control in severe cases.
- Early diagnosis and multidisciplinary management are crucial for optimizing outcomes in high-risk pregnancies complicated by placenta previa.
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