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Placenta Praevia Percreta Invading the Urinary Bladder
Author(s) -
Sanders R. R.
Publication year - 1992
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1992.tb02857.x
Subject(s) - placenta percreta , medicine , hysterectomy , placenta , caesarean section , obstetrics , placenta previa , pregnancy , gynecology , surgery , fetus , genetics , biology
EDITORIAL COMMENT: We accepted this case for publication for readers to contrast the pros and cons of conservative management of placenta praevia percreta when hysterectomy appears a formidable undertaking and haemorrhage from a partially separated placenta does not render immediate hysterectomy a necessity. The author was very careful to avoid disturbance of the placenta at Caesarean section. The author's letter to the editor quoted experience of a fatal case of placenta praevia percreta and the editor unfortunately can say the same. The deaths from placenta praevia percreta as stated in most triennial reports of Maternal Deaths in Australia usually occur because of failure to achieve lasting haemostasis at the time of Caesarean section followed by further surgery when the patient has lost a large quantity of blood (1985–1987 report; p24). The finesse used in this successfully treated patient is only feasible when haemorrhage has not occurred. We have previously commented that when performing hysterectomy for placenta praevia percreta it is probably wise to perform classical Caesarean section, close the uterus with the placenta undisturbed, and proceed to hysterectomy, perhaps with elective incision of the bladder wall if there is no plane between it and the lower uterine segment (see Editorial Comment. Aust NZ J Obstet Gynaecol 1991; 31: 71; see also Obstetrics and the Newborn, Beischer NA, Mackay EV, WB Saunders, Second Edition 1986; pi04 for photographs of a patient with a placenta praevia percreta treated as described above). Whenever the eventual hysterectomy is performed the main prerequisite, apart from a skilled anaesthetist and appropriate resuscitation facilities, is a surgeon familiar with radical pelvic surgery; this usually means a gynaecological oncologist. Summary: A case of placenta praevia percreta involving the urinary bladder is presented. A classical Caesarean section was performed at 35 weeks' gestation but the placenta was left in situ and an elective hysterectomy was successfully performed 2 weeks postpartum.