PLACENTA PREVIA PERCRETA WITH BLADDER INVOLVEMENT - NEW CONSIDERATIONS AND REVIEW OF THE LITERATURE

Placenta previa percreta is a life-threatening condition. Antenatal di agnosis is important to establish and to optimize a plan of management . When bladder invasion occurs, Other potential complications can resu lt, including massive hemorrhage and the development of disseminated i ntravascular coagulation. Numerous modalities have been wed successful ly to treat these patients, but hysterectomy at delivery is the treatm ent most commonly used. A case of placenta previa percreta with suspec ted bladder invasion was diagnosed in a 35-year-old woman by routine o ffice ultrasound examination at 19 weeks 6 days' gestation. She was ma naged conservatively until 36 weeks 3 days' gestation, at which time s he underwent a modified classical Cesarean section after amniocentesis to confirm fetal lung maturity. The placenta was left in situ immedia tely postpartum. The patient underwent a prophylactic embolization of her hypogastric arteries and received methotrexate chemotherapy. Eight weeks later, she developed a low-grade coagulopathy and underwent a t otal abdominal hysterectomy. Conservative management intrapartum is th ought to be appropriate, to avoid the risk of severe hemorrhage at the time of delivery. However, elective hysterectomy ought to be consider ed earlier (2-4 weeks postpartum) than the time suggested in the liter ature, to avoid the development of further complications, including co agulopathy.