title: Conservative management of placenta previa percreta in a Jehovah's Witness.
abstract: BACKGROUND
  Hemorrhage is a serious threat with placenta accreta, often requiring aggressive operative intervention by hysterectomy and resuscitative measures with large-volume blood replacement to ensure survival. Refusal to accept transfusion makes management especially difficult.
  
  
  METHODS
  We report a Jehovah's Witness patient who had 9 previous cesarean deliveries and presented with anemia and placenta previa percreta invading the bladder wall. Management objectives were to enhance the patient's status, using erythropoietin and autologous transfusion, and to minimize the chance of hemorrhage by prophylactic uterine artery embolization. The placenta was left in situ after the delivery with no untoward consequences. Methotrexate was held in readiness, but was not required as adjuvant therapy.
  
  
  CONCLUSIONS
  Effective care of such patients requires close collaborative team effort and advanced planning to ensure a good outcome.
authors.affiliation: Department of Obstetrics and Gynecology, Wyckoff Heights Medical Center, Brooklyn, New York, 11237, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Weinstein
authors.forename: Prasanta
authors.initials: P
authors.lastname: Chandra
authors.forename: Henry
authors.initials: H
authors.lastname: Schiavello
authors.forename: Adiel
authors.initials: A
authors.lastname: Fleischer
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033221:Jehovah's Witnesses; D010923:Placenta Previa / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D018570:Risk Assessment; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy
chemical_list: D004921:Erythropoietin