Cesarean hysterectomy requiring emergent thoracotomy: a case report of a complication of placenta percreta requiring a multidisciplinary effort.
BACKGROUND
Currently a leading indication for cesarean hysterectomy among multiparous women, placenta accreta is associated with significant maternal morbidity and mortality.


METHODS
A 34-year-old woman with a pregnancy complicated by placenta previa and previous cesarean deliveries was transferred to our institution following late diagnosis of placenta percreta. She underwent cesarean hysterectomy complicated by substantial hemorrhage. Massive blood product replacement precipitated severe hyperkaIemia and hypocalcemia with resultant asystole. Cardiac bypass with concomitant obligate anticoagulation was temporarily required while normalizing the patient's electrolytes. Numerous surgical and medical interventions were required to achieve hemostasis, and the patient survived to hospital discharge with moderate residual morbidity.


CONCLUSIONS
Optimal management of placenta accreta requires a multidisciplinary approach within a tertiary center possessing extensive resources necessary for managing the most severe complications.
Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA. smp9009@med.cornell.edu
Shai
S
Pri-Paz
Patricia C
PC
Devine
Russell S
RS
Miller
Pamela D
PD
Flood
Sherelle L
SL
Laifer-Narin
Jason D
JD
Wright
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D004638:Emergency Treatment; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D010923:Placenta Previa / Q000601:surgery*; D011247:Pregnancy; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000517:prevention & control