Elective non-removal of the placenta and prophylactic uterine artery embolization postpartum as a diagnostic imaging approach for the management of placenta percreta: a case report.
BACKGROUND
Placenta percreta, invasion of placental tissue through the uterine wall, is a rare but potentially fatal complication of pregnancy. Historically, the diagnosis was made at laparotomy, usually during Caesarean hysterectomy.


METHODS
We describe a case of placenta percreta, in which the placenta was allowed to remain fixed to the uterine wall. Antenatal ultrasound and magnetic resonance imaging techniques were used to establish the diagnosis and guide clinical management. Elective postoperative uterine artery embolization down balloon catheters was used to prevent postpartum hemorrhage and to promote involution and shedding of the placenta. After 6 months, the uterus had involuted to the nonpregnant state.


CONCLUSIONS
New diagnostic imaging techniques may be used to guide conservative management of placenta percreta, thereby maintaining fertility and avoiding hemorrhage, blood transfusion, and hysterectomy.
Maternal-Fetal Medicine Division, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, ON.
Fawaz
F
Alkazaleh
Michael
M
Geary
John
J
Kingdom
John R
JR
Kachura
Rory
R
Windrim
D000328:Adult; D001158:Arteries; D002404:Catheterization / Q000379:methods; D002585:Cesarean Section; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007813:Laparotomy; D010922:Placenta Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000517:prevention & control; D014599:Uterus / Q000098:blood supply*