title: Medical and surgical treatment of placenta percreta to optimize bladder preservation.
abstract: 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.
authors.affiliation: 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
authors.forename: Paula S
authors.initials: PS
authors.lastname: Lee
authors.forename: Ryan
authors.initials: R
authors.lastname: Bakelaar
authors.forename: C Brennan
authors.initials: CB
authors.lastname: Fitpatrick
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Ellestad
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Angeles
authors.initials: A
authors.lastname: Alvarez Secord
mesh_terms: 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
chemical_list: D019384:Nucleic Acid Synthesis Inhibitors; D008727:Methotrexate