Massive postpartum haemorrhage after uterus-conserving surgery in placenta percreta: the danger of the partial placenta percreta.
Placenta percreta is a rare but potentially life-threatening condition associated with high maternal mortality and morbidity rates, usually arising from severe obstetric haemorrhage. Due to rising caesarean section rates, an increase in the incidence of morbidly adherent placentas (accreta, increta and percreta) has been observed. Various treatment strategies have been employed in different centres, ranging from performing a caesarean hysterectomy at the time of delivery to leaving the placenta in situ, with or without adjuvant internal iliac and uterine arterial embolisation and/or methotrexate therapy. In the case of placenta percreta, irrespective of the treatment method employed, women are still at high risk of life-threatening haemorrhage and morbidity secondary to placental invasion beyond the confines of the uterine serosa into surrounding organs, most commonly the bladder. We describe an unusual case of a partially adherent placenta percreta in which partial separation of the normally implanted placenta led to torrential haemorrhage on the third postoperative day after the placenta was left in situ at the time of delivery. We therefore advise caution in following a conservative approach in the treatment of cases of placenta percreta in which the percreta feature is only partial and will discuss the merits and disadvantages of alternative options.
Teo
S B L
SB
Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore. Dr.Steven.Teo@gmail.com
Kanagalingam
D
D
Tan
H-K
HK
Tan
L-K
LK
D000328:Adult; D005260:Female; D006801:Humans; D010921:Placenta Accreta / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D014599:Uterus / Q000601:surgery*