title: Failure of conservative management of placenta previa-percreta.
abstract: We present a patient with a placenta previa in which we failed to manage conservatively with methotrexate and uterine embolization. The patient was diagnosed in the second trimester as having a possible placenta previa-increta,and underwent a repeat classical cesarean delivery at 32 weeks of gestation due to significant antepartum vaginal bleeding. Following abdominal closure,the uterine vessels were embolized with the Gel-Foam by interventional radiology. The placenta previa was left in-situ and patient was discharged home in stable condition in five days. The patient reported on the 44th postoperative day with heavy vaginal bleeding. A total abdominal hysterectomy was performed due to an unstable patient's hemodynamic condition in association with fluid resuscitation and multiple blood transfusions. The pathologic findings revealed a 675 g uterus with placenta previa-percreta with extension of chorionic villi to the serosal layer. Our case demonstrates a need for careful selection of patients with placenta previa and suspected accreta/increta/percreta that would be suitable candidates for conservative medical management. Patients who opt for conservative medical management should be informed about the possibility of catastrophic bleeding associated with a retained placenta, that would ultimately require blood transfusions and hysterectomy.
authors.affiliation: Weill Medical College of Cornell University, New York, NY 10021, USA.
authors.forename: Guoyang
authors.initials: G
authors.lastname: Luo
authors.forename: Sriram C
authors.initials: SC
authors.lastname: Perni
authors.forename: Claudel
authors.initials: C
authors.lastname: Jean-Pierre
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Baergen
authors.forename: Mladen
authors.initials: M
authors.lastname: Predanic
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000627:therapeutic use; D010923:Placenta Previa / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D011247:Pregnancy; D017211:Treatment Failure; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply
chemical_list: D008727:Methotrexate