Placenta previa percreta with bladder invasion presenting as incarcerated hernia

Prophylactic trans-uterine embolization to reduce intraoperative blood loss for placenta percreta invading the urinary bladder

Reported herein is the case of a 35-year-old multipara woman diagnosed (on sonography) with total placenta previa that had ruptured through the myometrium of the uterus, invading the wall of the urinary bladder. In the 32nd week of gestation the patient underwent an emergency cesarean section due to profuse vaginal bleeding. Due to possible intraoperative massive bleeding during removal of the placenta it was decided to preserve the uterus and placenta temporarily. The patient underwent superselective trans-uterine embolization through the bilateral anterior branches of the hypogastric arteries, using gelfoam cubes and coils. Two days later cesarean hysterectomy was performed, and the placenta was successfully removed from the invaded urinary bladder. The whole procedure went smoothly and the estimated blood loss was only 1300 mL.

Placenta accreta in Kuwait: does a discrepancy exist between fundal and praevia accreta?

OBJECTIVE

The purpose of this retrospective study was to compare maternal and neonatal outcome in relation to site of placenta accreta by stratifying the site of placenta accreta into upper and lower uterine segment implantation.

SUBJECTS AND METHODS

Sixteen cases of placenta accreta which were reported in the Maternity Hospital of Kuwait over 11 years from January 1981 to July 1993 - (1990 and 1991 excluded) were retrospectively analyzed using the hospital medical records.

RESULTS

The incidence of placenta accreta was 9.8 per 100,000 deliveries. The rate of accreta in patients with placenta praevia was 880 per 100,000 placenta praevia, compared to a rate of 5 accreta per 100,000 placenta implanting in the upper uterine segment. There were no differences between accreta found in the upper segment and lower segment for maternal and neonatal mortality, maternal complication, past obstetric history and possibility of conserving the uterus. Significant differences were found in the birth weight, gestational age at birth, antenatal symptoms, time of diagnosis and mode of delivery when accreta was stratified by site of implantation.

CONCLUSION

Placenta praevia is a definite risk factor for placenta accreta. Combined abnormal penetration of placenta as in accreta and abnormality in site as in praevia does have a significant clinical implications.

Placenta percreta with bladder invasion: surgical strategy to avoid massive blood loss

Placenta percreta with bladder invasion is a rare complication of pregnancy, causing life-threatening hemorrhage. We report two further cases. In the second case we opted for a specific surgical guideline based on immediate ligature of both the hypogastric arteries before hysterectomy. This approach resulted in considerably less blood loss than is usually reported.