Antenatal diagnostic aspects of placenta percreta and its influence on the perinatal outcome: a clinical case and literature review

Abstract

Background.Placenta percreta is a very rare, but extremely life-threatening obstetrical pathology for the mother and the child, especially in the cases when it is not diagnosed before the birth and when it results in massive bleeding and a dramatic deterioration of condition. It is extremely important to diagnose this pathology as early as possible and plan further optimal care of patients in order to minimize life-threatening complications.Case report.The paper presents an illustrated clinical case of placenta percreta determined before the birth. Features of visual diagnostics are discussed.A 32-year-old pregnant woman with a history of two caesarean deliveries arrived at the tertiary level hospital at 22 weeks of gestation due to abdomen pain. Placenta previa was diagnosed and ultrasound, magnetic resonance imaging suggesting placenta percreta were seen. On the 32nd week, the planned caesarean hysterectomy was performed. The balloon catheters to occlude the internal iliac arteries and minimize bleeding during the surgery were used.Conclusions.Antenatal diagnosis of placenta percreta is especially important. Methods of visual diagnostics are complementary. The optimal surgical approach during caesarean hysterectomy remains controversial. In the case of the slow oozing without a clearly identified source of bleeding after hysterectomy and internal iliac arteries balloons deflation, ligation of one of the internal iliac arteriescan be reasonable to avoid residual haemorrhage and relaparotomy.

Massive Adherent Placenta, Placenta Percreta

“…In this patient, placenta percreta was undiagnosed because of the absence of clinical and sonographic features that support it and the incidence of placenta accreta without characteristic features is very rare (Volochovič et al, 2016).…”

Preokliuzinių balionėlių naudojimas perioperaciniam kraujavimui mažinti esant invazyviai placentai: tretinio lygio stacionaro patirtis ir literatūros apžvalga

“…Jos pasireiškimo dažnis didėja. Šiai patologijai valdyti ypač svarbi antenatalinė diagnostika, nėštumo priežiūra bei organizuotas komandinis gydytojų darbas gimdymo metu [7].…”

Anesthetic implications in managing a case of placenta percreta: A case report

“…3 Antenatal diagnosis of placenta percreta is by ultrasound scan and magnetic resonance imaging (MRI). 4 Intraoperative management of bleeding placenta percreta involves the formation of a team to manage the bleeding, maintain the circulating volume, and optimize the oxygen-carrying capacity which involves maintaining adequate hemoglobin by transfusion of blood products, and antifibrinolytic therapy, correction of electrolytes, serial blood gases to guide the therapy coagulation studies and rotational thermoelectrometry (ROTEM). 5…”