Atypical presentation of placenta percreta post-partum-a conservative surgical approach

Abstract

We report our experience with an atypical presentation of placenta percreta, presenting as a mass-like bulge in the uterine fundus. A hemodynamically stable young lady status-post preterm delivery at 26 weeks was referred to our center on the third post-partum day after multiple failed attempts at removal of a retained placenta. Magnetic resonance imaging (MRI) showed an atypical fibroid with part of an adherent placenta. Uterine artery embolization was done prophylactically. After a failure at removal under USG guidance, a diagnostic laparoscopy revealed an 8x6 cm highly vascular mass in the fundus extending to the right cornua with intact serosa, possibly placenta percreta. The procedure converted to laparotomy and the mass removed. Histopathology confirmed a placenta percreta. However, the neonate admitted at the referring hospital expired on day 14 due to sepsis. Post-partum adherent placenta in the fundal region on MRI can mimic an atypical fibroid.