Management of placenta percreta in a Jehovah’s Witness patient

Abstract

Placenta percreta is increasing in incidence and is associated with the risk of life-threatening haemorrhage. Patients who do not accept blood products present a unique challenge to obstetrician-gynaecologists. In this case report, we present the case of a 42-year-old pregnant Jehovah's Witness with a complete placenta previa and confirmed percreta at 26 weeks' gestation. Due to her religious beliefs against the use of blood products, she was managed with a stepwise surgical approach which involved caesarean delivery with internal iliac (hypogastric) artery ligation, weekly methotrexate and delayed hysterectomy 6 weeks later. Non-traditional, alternative approaches to the management of abnormal placentation in patients declining blood products warrant exploration.

Conservative Blood Management in a Jehovah's Witness with Placenta Percreta: A Case Report and Transfusion Trigger Questioning

“…Placenta percreta normally extends to extra-uterine tissue and, during the surgery, is associated with the risk of damage to local organs, neurovascular invasion, hemorrhage and disseminated intravascular coagulation. The standard treatment for this condition is cesarean hysterectomy, which has been associated with high maternal morbidity and peri-operative average blood loss of 4800 ml in these cases [1]. Accretism may be detected by ultrasound and confirmed by magnetic resonance, however in some cases diagnosis is made only at the time of delivery, which compromises pre-operative planning.…”