Placenta Previa et Percreta: A Potentially Life-Threatening Condition

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Surgery

Background:

• Placenta accreta spectrum (PAS) encompasses conditions where placental tissue invades the uterine wall.
• Placenta percreta, the most invasive form, involves placental invasion through the myometrium and into adjacent organs.
• Increasing Cesarean section (CS) rates are associated with a higher incidence of PAS.

Purpose of the Study:

• To highlight the critical role of prenatal diagnosis in managing placenta percreta.
• To emphasize the importance of interdisciplinary collaboration in optimizing patient outcomes for rare and severe obstetric complications.
• To illustrate a case of placenta percreta with Cesarean section scar infiltration.

Main Methods:

• A case report of a 34-year-old multiparous woman at 34 weeks gestation with suspected placenta percreta.
• Diagnosis confirmed via transvaginal ultrasound, revealing placenta previa totalis et percreta with bladder involvement.
• Management involved an interdisciplinary team, Cesarean section, and subtotal hysterectomy due to life-threatening hemorrhage.

Main Results:

• Prenatal ultrasound was instrumental in diagnosing placenta previa et percreta, guiding surgical planning.
• Intraoperative findings confirmed placenta percreta with Cesarean section scar infiltration.
• Histological confirmation validated the diagnosis, and subtotal hysterectomy was performed to control hemorrhage.

Conclusions:

• Prenatal diagnosis of placenta percreta is vital for effective management and reducing maternal-fetal morbidity/mortality.
• Interdisciplinary cooperation among prenatal diagnosticians, obstetricians, and anesthesiologists in specialized centers is essential.
• The management of placenta percreta, particularly with scar infiltration, requires a coordinated approach to mitigate risks associated with this severe PAS variant.