Percutaneous treatment of placenta percreta using coil embolization.
OBJECTIVE
To report the use of embolotherapy to avoid hysterectomy in rare placenta percreta.


METHODS
A pregnant 34-year-old woman (gravida 3, para 2) was admitted with premature rupture of membranes and vaginal bleeding in the 32nd week. Prenatal B-mode and Doppler ultrasound revealed marked hypervascularity of the placenta with disruption of the uterine-bladder interface consistent with placenta percreta. Since the patient insisted on uterine preservation, uterus and placenta were left in situ after caesarean section, which was followed by coaxial microcoil embolization of 6 pelvic arteries and postoperative methotrexate administration. Three months later, the patient had severe bleeding from the retained placenta, possibly under the influence of anticoagulation administered for pulmonary embolism. Emergent hysterectomy was performed.


CONCLUSIONS
Coil embolization may avoid immediate hysterectomy and reduce peri-delivery blood loss in placenta percreta. However, retained placenta poses a serious risk, even after months, and secondary hysterectomy should be performed as an elective procedure after embolization.
Dinkel
Hans-Peter
HP
Department of Diagnostic Radiology, University Hospital of Bern, Switzerland. hans-peter.dinkel@insel.ch
Dürig
Peter
P
Schnatterbeck
Peter
P
Triller
Jürgen
J
D000328:Adult; D000792:Angiography; D002585:Cesarean Section; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D010921:Placenta Accreta / Q000000981:diagnostic imaging / Q000628:therapy*; D011247:Pregnancy; D014463:Ultrasonography; D014599:Uterus / Q000098:blood supply