title: [Placenta percreta with bladder and rectum invasion].
abstract: BACKGROUND
  Placenta percreta may lead to massive obstetric haemorrhage, haemodynamic decompensation, and ultimately death. Total obstetric hysterectomy is universally accepted as treatment; however, the emergence of new techniques such as the uterine artery angioembolisation approach, and the use of chemotherapy agents such as methotrexate, are alternatives also described in the literature.
  
  
  METHODS
  A 28 year-old patient, in her fourth gestation, with a previous history of 2 vaginal and 1 caesarean birth 4, in her 28.4 week of pregnancy, by second trimester ultrasound, was diagnosed with placenta percreta with bladder and rectal invasion using magnetic resonance imaging. Multidisciplinary and sequential treatment included: Caesarean with placenta in situ, uterine artery embolisation immediately after caesarean, chemotherapy with methotrexate weekly for 4 doses, and finally obstetric hysterectomy after bilateral hypogastric artery ligation. The outcome was favourable and the patient was discharged in good general condition.
  
  
  CONCLUSIONS
  The protocoled and sequential management including selective embolization immediately after caesarean section with placenta in situ, weekly chemotherapy with methotrexate and obstetric hysterectomy, preceded by bilateral ligation of the hypogastric arteries, is a therapeutic alternative to be considered in cases of placenta percreta.
authors.affiliation: Medicina Crítica en Obstetricia, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México. Electronic address: lanciomed@hotmail.com.
authors.forename: Froilán
authors.initials: F
authors.lastname: Tórrez-Morales
authors.affiliation: Unidad de Terapia Intensiva de Ginecología y Obstetricia, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.
authors.forename: Jesús Carlos
authors.initials: JC
authors.lastname: Briones-Garduño
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003131:Combined Modality Therapy; D003558:Cystoscopy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced; D007044:Hysterectomy; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D010921:Placenta Accreta / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology; D012007:Rectum / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D055988:Uterine Artery; D014592:Uterine Hemorrhage / Q000209:etiology
chemical_list: D008727:Methotrexate
keywords: Chemotherapy; Embolisation; Embolización; Percretismo placentario; Placenta accreta; Quimioterapia