Placenta previa percreta with surrounding organ involvement: a proposal for management

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Oncology

Background:

• Placenta accreta spectrum (PAS) includes morbidly adherent placentas.
• Placenta percreta (grade 3E PAS) involves deep myometrial invasion and potential adjacent organ involvement.
• Maternal morbidity and mortality are significant in grade 3E PAS, complicating surgical management.

Purpose of the Study:

• To propose a step-by-step schema for evaluating grade 3E placenta percreta.
• To guide treatment decisions between immediate hysterectomy and conservative management.
• To optimize patient care for invasive placental disease.

Main Methods:

• Antenatal evaluation using ultrasound and MRI to assess placental invasion.
• Multidisciplinary team approach for planned cesarean delivery.
• Intraoperative assessment including surgical field evaluation, cystoscopy, and transvaginal ultrasound.
• Consideration of uterine artery embolization, tranexamic acid, ureteral stenting, and resuscitative endovascular balloon occlusion of the aorta.

Main Results:

• The proposed schema aids in determining the safety of primary cesarean hysterectomy.
• Conservative management with planned delayed hysterectomy is recommended if safe resection is uncertain.
• This approach aims to reduce catastrophic hemorrhage and organ damage.

Conclusions:

• A structured evaluation is crucial for managing complex placenta percreta cases.
• Individualized treatment decisions balance surgical risks and benefits.
• This schema supports informed choices for placenta percreta management, prioritizing maternal safety.