Placenta percreta with bladder invasion as a cause of life threatening hemorrhage

Purpose: Abnormal placental penetration through the myometrium with bladder invasion is a rare obstetric complication with potential for massive blood loss. Urologists are usually consulted after a life threatening emergency has already arisen. Their familiarity with this condition is crucial for ef fective management. We describe 2 cases of placenta percreta with bladder i nvasion to highlight the catastrophic nature of this clinical entity, and r eview the literature on current diagnostic and management strategies. Materials and Methods: Between 1986 and 1998, 250 cases of adherent placent a (0.9%) were identified in 25,254 births at our institution, including 2 ( 0.008%) of placenta percreta with bladder invasion. We treated these 2 mult iparous women who were 33 and 30 years old, respectively. Each had undergon e 2 previous cesarean sections. Results: Presenting symptoms were severe hematuria in 1 patient and prepart um hemorrhage with shock in the other. Ultrasound showed complete placenta previa in each with evidence of bladder invasion in 1 patient. Hysterectomy , bladder wall resection and repair, and bilateral internal iliac artery li gation were required to control massive intraoperative hemorrhage, The pati ents received 22 and 15 units of packed red blood cells, respectively. Feta l death occurred in each case. Convalescence was complicated by disseminate d intravascular coagulation in patient 1 but subsequent recovery was uneven tful. Conclusions: A high index of suspicion for placenta percreta with bladder i nvasion is required when evaluating pregnant women with a history of cesare an delivery and placenta previa who present with hematuria and lower urinar y tract symptoms. Ultrasonography and magnetic resonance imaging may assist in establishing the diagnosis preoperatively. With proper planning and a m ultidisciplinary approach fetal and maternal morbidity and mortality may be decreased.