Placenta percreta with invasion of the bladder wall: management with a multi-disciplinary approach

Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach

“…Several studies have reported improved clinical outcome if placenta accreta is managed with a planned cesarean hysterectomy, in contrast to emergency surgery at the time of an unscheduled delivery. 5,11,12,14 These findings highlight the importance of having a defined strategy for the management of placental invasion. Although we did not show a defined benefit in cases of accreta only, this should not be considered as evidence to support attempting such cases in a less capable environment.…”

“…20 Most groups who described a multidisciplinary approach to the management of placenta accreta have included a gynecologic oncologist in addition to an MFM specialist as the core members of their team, along with a urologist, an interventional radiologist, and vascular surgeon providers. 5,11,12,14 In our protocol, an interventional radiologist was always made aware of the case but was not necessarily present in the operating room, unless a procedure was requested. Preoperative intravascular balloon catheters are not a standard part of our protocol, given the current controversy regarding this intervention.…”

“…5 Such an approach is recommended particularly in cases of more aggressive placental invasion, such as placenta increta or percreta. 11,12 Planned preterm delivery 13 and a staged procedure with intraoperative arterial embolization 14 are 2 strategies that have also been reported to improve outcomes.…”

Intraoperative Surgical Treatment of Undiagnosed Placenta Percreta

“…It enables MRI to more clearly delineate the outer placental surface relative to the myometrium, and differentiate between the heterogeneous vascular signals within the placenta from those caused by maternal blood vessels. A multidisciplinary approach by a team of experienced obstetricians, anaesthetists, nurses, interventional radiologists, neonatologists, urologists and blood bank officers ensures the best outcomes [16]. It is fundamental that obstetricians are aware of the risk factors and diagnostic modalities for placenta accreta because of its potential emergent nature and the associated risk of life-threatening haemorrhage.…”

Placenta percreta with bladder invasion: a rare cause of hematuria in pregnancy

“…[11] Hastada masif kanamanın sebep olabileceği olumsuzlukları önlemek için gerekli hazırlıklarda bulunmak anestezi uzmanının önceliği olmalıdır. Operasyon öncesi mevcut kırmızı kan hücre miktarının hesaplanması, perioperatif etkin hemodinamik monitörizasyon, vücut ısısına göre ayarlanmış sıvıların hızlı verilecek şekilde sistemin hazırlanması, verilebilecek bütün banka kan ürünlerinin hazırlanması anestezi ekibi tarafından sağlanmalıdır.…”