Successful management of placenta percreta by cesarean hysterectomy with transverse uterine fundal incision
Keywords:
Placenta previa, Placenta accreta, Placenta percreta, Transverse uterine fundal incision, Cesarean hysterectomyAbstract
Placenta accreta presents one of the highest risks to pregnancy, and its more severe variant, placenta percreta, is particularly risky. The incidence of both conditions is increasing. Placenta percreta requires a cesarean hysterectomy for management, but the challenges associated with this surgery often result in severe obstetric hemorrhaging and high rates of maternal morbidity. Several recent obstetric studies have reported on the usefulness of the transverse uterine fundal incision for the management of placenta accreta and its variants. However, these reports included only a few cases of placenta percreta. Here we present a case of placenta percreta covering the anterior uterine wall that was successfully managed using a transverse fundal incision, which avoided incising the placenta at delivery and thus reduced maternal blood loss. After delivery, the patient underwent a total abdominal hysterectomy without the need for a blood transfusion. We conclude that a transverse uterine fundal incision can be very useful for the management of placenta percreta of the anterior uterine wall.
References
Belfort MA. Placenta accreta. Am J Obstet Gynecol. 2010;203:430-9.
Clausen C, Lonn L, Langhoff-Roos J. Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand. 2014;93:138-43.
Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107:1226-32.
Sumigama S, Itakura A, Ota T, Okada M, Kotani T, Hayakawa H et al. Placenta previa increta/percreta in Japan: a retrospective study of ultrasound findings, management and clinical course. J Obstet Gynaecol Res. 2007;33:606-11.
Clausen C, Stensballe J, Albrechtsen CK, Hansen MA, Lonn L, Langhoff-Roos J. Balloon occlusion of the internal iliac arteries in the multidisciplinary management of placenta percreta. Acta Obstet Gynecol Scand. 2013;92:386-91.
Wong VV, Burke G. Planned conservative management of placenta percreta. J Obstet Gynaecol. 2012;32:447-52.
Canonico S, Arduini M, Epicoco G, Luzi G, Arena S, Clerici G et al. Placenta previa percreta: a case report of successful management via conservative surgery. Case Rep Obstet Gynecol. 2013;2013:702067.
Ward CR. Avoiding an incision through the anterior previa at cesarean delivery. Obstet Gynecol. 2003;102:552-4.
Kotsuji F, Nishijima K, Kurokawa T, Yoshida Y, Sekiya T, Banzai M et al. Transverse uterine fundal incision for placenta praevia with accreta, involving the entire anterior uterine wall: a case series. BJOG. 2013;120:1144-9.
Nishida R, Yamada T, Akaishi R, Kojima T, Ishikawa S, Takeda M et al. Usefulness of transverse fundal incision method of cesarean section for women with placentas widely covering the entire anterior uterine wall. J Obstet Gynaecol Res. 2013;39:91-5.
