Ureter injury in obstetric hysterectomy with placenta accreta spectrum: Case report

Abstract

Introduction and importance Placenta accreta spectrum (PAS) is a state of abnormal attachment of the placenta, including placenta accreta, placenta increta, and placenta percreta. This condition can be life-threatening due to the placenta cannot spontaneously separated, resulting in continuous bleeding. Cesarean section followed by hysterectomy is one of the treatment options for PAS. There was a great liability for urinary tract injuries during the operation of PAS patient. Case presentation We present the case of ureter injury during subtotal hysterectomy in patient with PAS. A 30-years-old female patient was diagnosed with recurrent antepartum hemorrhage due to placenta previa accreta spectrum on G2P1 33 weeks of gestational age, singleton live breech presentation, previous c-section 1×. After uterine transverse incision, the baby was delivered. We decided to perform subtotal hysterectomy. There was severe adhesion. On the exploration after subtotal hysterectomy was performed, we found ruptured of the right ureter. Clinical discussion Hysterectomy peripartum is one of the treatment of PAS, either to prevent or to control postpartum hemorrhage. In pregnant women with morbid placental adherence, there was a great liability for urinary tract injuries. Distal ureters are the most commonly injured while hysterectomy. Injuries to the ureters in this patient occurred due to severe adhesions and unclear visual organ. Conclusion Although it is rare, ureter injury may occur during subtotal hysterectomy in patient with placenta accreta spectrum. To prevent that condition, inserting ureter stent can be perform before the operation. Multidisciplinary approach is carried out so that patient outcomes are good.

An Ominous Case of Uterine Rupture in an Unscarred Womb and Its Subsequent Management

“…Extensive ruptures may necessitate a hysterectomy to control bleeding and avert further complications. Healthcare providers should prioritize preventing complications and ensuring successful patient outcomes, such as ureteric DJ stenting [ 14 ]. A multidisciplinary approach involving urologists, anesthesiologists, and intensivists can significantly mitigate complications, as observed in the current case [ 14 ].…”

“…Healthcare providers should prioritize preventing complications and ensuring successful patient outcomes, such as ureteric DJ stenting [ 14 ]. A multidisciplinary approach involving urologists, anesthesiologists, and intensivists can significantly mitigate complications, as observed in the current case [ 14 ]. Preventing uterine rupture in unscarred uteri involves thorough antenatal care, vigilant labor monitoring, and elective cesarean delivery in some cases.…”

Literature Review: Placental Morphology of Pregnant Woman With the Covid-19

“…Hal ini didukung oleh penelitian (Bouachba et al, 2021b) yang menyatakan volume plasenta pada ibu hamil yang terinfeksi Covid-19 pada usia kehamilan kurang 18 minggu jika diukur dengan MRI cenderung lebih kecil. Penelitian (Djusad et al, 2021) juga menemukan perbedaan berat plasenta pada ibu hamil dengan Covid-19 tetapi perbedaan yang ditemukan tidak mencapai hasil signifikansi secara statistik. Hasil yang mengejutkan diungkapkan oleh (Gao et al, 2021) yang menyatakan tidak ada perbedaan yang signifikan berat plasenta pada ibu hamil dengan Covid-19 dengan berat plasenta pada kasus IUGR.…”

Early Detection of Adhesive Placenta Previa in Cesarean Section

“…Prematurity is a major cause of perinatal death even though the management of placenta previa has been carried out properly. Besides the problem of prematurity, bleeding due to placenta previa will be fatal for the mother if there is no immediate preparation of blood or blood components [2].…”