Intraoperative Discovery of Placenta Percreta With Bladder Invasion During Emergency Cesarean Section Following...

Placenta percreta, the most severe form of placenta accreta spectrum (PAS), is a rare but life-threatening obstetric condition in which abnormal placental invasion extends beyond the uterine myometrium into adjacent organs, most frequently the urinary bladder. Preoperative imaging may suggest the diagnosis yet substantially underestimate the true depth of invasion, a discrepancy that carries potentially catastrophic consequences. We report the case of a 34-year-old woman with two prior cesarean sections who presented at 25 weeks of gestation in active preterm labor with a dichorionic-diamniotic twin pregnancy. Antenatal ultrasound raised suspicion for PAS, but full-thickness bladder wall invasion was confirmed only upon surgical exploration. After delivery of both twins, a total hysterectomy with en bloc partial posterior cystectomy and bilateral ureteral stenting was required. The procedure was complicated by massive hemorrhage, refractory hemodynamic shock, and an asystolic cardiac arrest from which return of spontaneous circulation was achieved within approximately one minute following immediate cardiopulmonary resuscitation and intravenous epinephrine as part of a coordinated multidisciplinary resuscitation effort. The patient achieved complete neurological recovery and was discharged on postoperative day 10. This case underscores that any sonographic suspicion of PAS, regardless of apparent severity, mandates maximal multidisciplinary preparedness and that survival with full neurological recovery following intraoperative cardiac arrest is attainable when resuscitation is prompt and protocol-driven.