Placenta Percreta Progression to Resistance Against Uterine Artery Embolization and Penetration Into the Bladder

TL;DR

A woman with a rare placental condition required multiple treatments and surgery to manage severe bleeding and bladder involvement.

Contribution

This case highlights the progression of placenta percreta and challenges in managing it with conservative methods.

Findings

Uterine artery embolization initially controlled bleeding but failed to prevent recurrence.

The placenta penetrated the bladder, necessitating surgical intervention for resolution.

Timely surgical intervention preserved bladder function despite extensive tissue involvement.

Abstract

A 31-year-old female sought termination of pregnancy due to a fetal body stalk anomaly diagnosed at 18 weeks of gestation. Despite an anterior placenta previa, successful vaginal delivery occurred. However, placental adhesion over a previous cesarean scar occurred, and part of the placenta could not be removed. Immediate postpartum bleeding prompted imaging studies, revealing extravasation from adherent placental remnants. Uterine artery embolization (UAE) provided initial hemostasis, but recurrent bleeding necessitated re-embolization. Although conservative treatment was initially pursued, significant hematuria prompted reevaluation, revealing extensive uterine wall and bladder penetration. Surgical intervention with total hysterectomy and partial bladder resection was performed, leading to the successful recovery of bladder function following surgical repair. While this case achieved a positive outcome, there is a potential for permanent urinary dysfunction if lesions are more extensive. While achieving a conservative cure is ideal, it is essential to assess the timing for opting for surgical intervention.

Figures