Placenta Percreta Previa Crossing Surgical Frontiers

TL;DR

This paper presents a complex case of placenta percreta with deep tissue invasion, highlighting the need for early diagnosis and multidisciplinary care to reduce maternal risks.

Contribution

The paper contributes a detailed clinical case report emphasizing the importance of prenatal screening and coordinated management in placenta percreta.

Findings

Placenta percreta with parametrial and uterine artery invasion requires radical hysterectomy and multiple reoperations.

Multidisciplinary care, including ICU admission and renal support, is crucial for patient stabilization.

Early diagnosis and improved prenatal screening can reduce maternal morbidity and mortality in placenta percreta cases.

Abstract

Placenta percreta represents a severe form of placenta accreta spectrum (PAS), characterized by the full-thickness invasion of placental villi through the uterine wall, often extending into adjacent structures. Its incidence is rising in parallel with the increased rates of cesarean sections and uterine interventions.

We report a case involving a patient 37+6 weeks of gestation with a history of four cesarean sections and inadequate prenatal surveillance that was admitted with symptoms of labor onset. Intraoperatively, the placenta was found to invade not only the myometrium but also the parametrial tissue and uterine arteries, complicating the surgical field. An emergency cesarean section was performed, resulting in the delivery of a neonate in excellent health. However, due to massive hemorrhage and extensive local invasion, the patient required a radical hysterectomy with bilateral salpingo-oophorectomy, alongside multiple reoperations to address ensuing complications such as hemoperitoneum and uroperitoneum.

The complexity of the case necessitated prompt multidisciplinary intervention, including hemostatic techniques, urological interventions and vigilant perioperative care. Administration to ICU, multidisciplinary management, encompassing renal support, urinary bladder repair, temporary nephrostomies, management of hospital infections, structured physiotherapy and speech therapy were crucial in stabilizing the patient and facilitating gradual recovery.

Placenta percreta with parametrial and uterine artery invasion is a challenging clinical scenario that demands early diagnosis and coordinated multidisciplinary management. Optimizing prenatal screening protocols and surgical preparedness is essential to mitigate the high risks of maternal morbidity and mortality associated with this condition.

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