Bladder Saving Hysterectomy for Placenta Praevia Percreta

Abstract

Background: Placenta accreta is an abnormally firm attachment of  placental villi to the uterine wall, which may cause postpartum hemorrhage. Placenta Percreta with invasion of the urinary bladder is a rare condition, which carries a high morbidity and mortality risk for mother and fetus.
Case Report: The present case is of 26 year old female who was diagnosed as a case of placenta percreta invading bladder during surgery. She was treated by cesarean hysterectomy with bilateral anterior branch of internal iliac artery ligation. The part of placenta adherent to wall of uterus and bladder was left in situ to save bladder. Overall 7 units of blood and 7 units of FFP given to patient preoperatively. Postoperatively methotrexate was given to the patient and followed with HCG levels.
Conclusion: A multidisciplinary approach for preoperative, intraoperative, and postoperative management of placenta previa percreta optimizes maternal outcome.