Medical and surgical treatment of placenta percreta to optimize bladder preservation.
BACKGROUND
Placenta percreta is associated with significant morbidity and mortality. Interventions are dictated by hemodynamic stability, desire to retain future fertility, and efforts to reduce surgical morbidity at time of delivery.


METHODS
Two cases of antenatally diagnosed placenta percreta with bladder invasion are presented. Conservative management was used, including endovascular interventions, leaving the placenta in situ, methotrexate, and delayed hysterectomy. Postoperative outcomes were acceptable, with no significant hemorrhagic complications or need for extensive bladder reconstruction.


CONCLUSIONS
Antenatal diagnosis of placenta percreta with bladder invasion is essential in the multidisciplinary management of this potentially catastrophic condition. A comprehensive approach including delayed hysterectomy after medical management resulted in an excellent clinical outcome.
Lee
Paula S
PS
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and Division of Maternal and Fetal Medicine, Duke University Medical Center, Durham, NC 27710, USA. paula.s.lee@duke.edu
Bakelaar
Ryan
R
Fitpatrick
C Brennan
CB
Ellestad
Sarah C
SC
Havrilesky
Laura J
LJ
Alvarez Secord
Angeles
A
D000328:Adult; D002404:Catheterization; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008727:Methotrexate / Q000627:therapeutic use; D019384:Nucleic Acid Synthesis Inhibitors / Q000627:therapeutic use; D010921:Placenta Accreta / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
D019384:Nucleic Acid Synthesis Inhibitors; D008727:Methotrexate