title: What should we do to optimise outcome in twin pregnancy complicated with placenta percreta? A case report.
abstract: BACKGROUND
  Patients with morbidly adherent placenta (MAP) are under risk of massive bleeding. It readily necessitates very complicated surgery and massive blood transfusion, and even leads to mortality. Cesarean hysterectomy (CH) is the procedure that is acknowledged worldwide, since it helps to minimize complications.
  
  
  METHODS
  A patient with dichorionic twin pregnancy underwent to cesarean section (CS) due to preliminary diagnosis of placenta percreta at her 35(th) week of pregnancy. Both of the placentas were left in situ. The patient admitted with signs of infection. Emergency total abdominal hysterectomy was performed 7 weeks after CS. In the course of hysterectomy, 3 units of erythrocyte suspension and 2 units of fresh frozen plasma were transferred, whereas none was required during CS.
  
  
  CONCLUSIONS
  Abandoning placenta in situ seems to be a logical alternative to the CH in patients with placenta percreta in order to minimize complications related to massive blood transfusion and surgical technique. However, it appears to increase maternal morbidity due to maternal infection in twin pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Uludag University School of Medicine, Bursa, Turkey. maralatalay@gmail.com.|Uludağ Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı, Görükle, 16059, Bursa, Turkey. maralatalay@gmail.com.
authors.forename: Mehmet Aral
authors.initials: MA
authors.lastname: Atalay
authors.affiliation: Department of Surgical Pathology, Uludag University School of Medicine, Bursa, Turkey. fzatalay@gmail.com.
authors.forename: Fatma
authors.initials: F
authors.lastname: Oz Atalay
authors.affiliation: Department of Obstetrics and Gynecology, Uludag University School of Medicine, Bursa, Turkey. drbilgecd@yahoo.com.
authors.forename: Bilge
authors.initials: B
authors.lastname: Cetinkaya Demir
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007239:Infections / Q000209:etiology / Q000601:surgery; D010921:Placenta Accreta / Q000601:surgery*; D010949:Plasma; D011247:Pregnancy; D059285:Pregnancy, Twin; D013997:Time Factors