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An abnormally attached placenta is unusual, having clinical importance due to mortality arising from consequent haemorrhage, perforation, invasion and injury of the urinary tract. Such abnormal adherence is associated with placental implantation on cicatrices resulting from a previous caesarean operation, uterine incision or curettage. Placenta percreta is defined as penetration of the whole uterine wall’s placental tissue, perforating its serous membrane. This abnormality can be identified before birth by imaging methods (ultrasound grey scale, pulsed colour Doppler or nuclear magnetic resonance). Conservative treatment is often inappropriate in these cases and surgical procedure becomes indicated.As the literature shows an increase in caesarean sections world-wide, the problem of placenta/accreta is likely to become more common and obstetricians will be faced with the decision to perform hysterectomy after caesarean section. The case presented here shows how of placenta percreta, with bladder involvement, was intra-operatively diagnosed and describes a multidisciplinary surgical team’s preoperative preparation and how a specific protocol was applied. The latter is considered fundamental for avoiding higher morbidity/mortality.

Placenta percreta: reporte de caso en relación con un protocolo quirúrgico obstétrico