title: Placenta Previa Percreta: A Case Report of Successful Management via Conservative Surgery.
abstract: Placenta percreta is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. We present a case of placenta previa percreta diagnosed by ultrasound and magnetic resonance imaging techniques, in which we accomplished conservative management of postpartum hemorrhage. The management we propose includes the following steps: preventive catheterization of the descending aorta via transhumeral access; Stark cesarean delivery; uterotonics drugs; Affronti endouterine square hemostatic sutures; intrauterine application of Bakri balloon and partial filling with 100 mL of normal saline; B Lynch suture, hysterorrhaphy, and filling a Bakri balloon with up to 500 mL of normal saline; reversible radiological embolization; and/or surgical ligation of the uterine arteries. The bleeding stopped following placement of Affronti sutures combined with external (B-Lynch suture) and internal (Bakri balloon) uterine compression. Our experience indicates that this conservative method can be considered an option in the management of selected cases of pregnancy at high risk for intrapartum hemorrhage.
authors: S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, 06132 Perugia, Italy.
authors: Silvia
authors: S
authors: Canonico
authors: Maurizio
authors: M
authors: Arduini
authors: Giorgio
authors: G
authors: Epicoco
authors: Giuseppe
authors: G
authors: Luzi
authors: Saverio
authors: S
authors: Arena
authors: Graziano
authors: G
authors: Clerici
authors: Giuseppe
authors: G
authors: Affronti
references: J Ultrasound Med. 2008 Sep;27(9):1275-81
references: 18716136
references: Am J Obstet Gynecol. 2007 May;196(5):e9-10
references: 17466689
references: Obstet Gynecol. 2000 Jul;96(1):129-131
references: 10928901
references: Br J Obstet Gynaecol. 1997 Mar;104(3):372-5
references: 9091019
references: Radiographics. 2008 Nov-Dec;28(7):1905-16
references: 19001647
references: Am J Obstet Gynecol. 2005 May;192(5):1458-61
references: 15902137
references: Am J Obstet Gynecol. 2009 Jun;200(6):632.e1-6
references: 19306969
references: Obstet Gynecol. 2002 Mar;99(3):502-6
references: 11864681
references: Obstet Gynecol. 2006 Apr;107(4):927-41
references: 16582134
references: Int J Gynaecol Obstet. 2010 Mar;108(3):191-3
references: 19945698
references: Acta Obstet Gynecol Scand. 2002 Aug;81(8):727-30
references: 12174156
references: J Chin Med Assoc. 2003 Dec;66(12):727-34
references: 15015822