Failed conservative management in a case of placenta percreta lead to total hysterectomy for haemostasis and bladder injury

Abstract

We describe an unfavourable outcome for the conservative management applied to a case of placenta percreta in a 32 year-old woman who referred to our obstetrics department with irregular vaginal bleeding. Her medical history pointed out she had undergone a corporeal caesarean one month before. Ultrasonography revealed a hyperechoic mass in the uterine cavity. After careful investigation by serial values of beta HCG, ultrasound, magnetic resonance imaging (MRI) and exploratory cystoscopy for assessing the degree of placental accretisation we decided to perform an inter-adnexal total hysterectomy with bilateral hypogastric artery ligation. To prevent immediate complications an early diagnosis and a prompt evaluation of the bleeding are important, while a careful follow up is also necessary for predicting any subsequent serious consequences.