Placenta previa percreta with bladder involvement: new considerations and review of the literature

Placenta previa percreta is a life-threatening condition. Antenatal diagnosis is important to establish and to optimize a plan of management. When bladder invasion occurs, other potential complications can result, including massive hemorrhage and the development of disseminated intravascular coagulation. Numerous modalities have been used successfully to treat these patients, but hysterectomy at delivery is the treatment most commonly used. A case of placenta previa percreta with suspected bladder invasion was diagnosed in a 35-year-old woman by routine office ultrasound examination at 19 weeks 6 days' gestation. She was managed conservatively until 36 weeks 3 days' gestation, at which time she underwent a modified classical Cesarean section after amniocentesis to confirm fetal lung maturity. The placenta was left in situ immediately postpartum. The patient underwent a prophylactic embolization of her hypogastric arteries and received methotrexate chemotherapy. Eight weeks later, she developed a low-grade coagulopathy and underwent a total abdominal hysterectomy. Conservative management intrapartum is thought to be appropriate, to avoid the risk of severe hemorrhage at the time of delivery. However, elective hysterectomy ought to be considered earlier (2-4 weeks postpartum) than the time suggested in the literature, to avoid the development of further complications, including coagulopathy.