Placenta percreta with bladder and rectum invasion

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• 作者：Froilá ; n Tó ; rrez-Morales^a ; ^{lanciomed@hotmail.com} ; Jesú ; s Carlos Briones-Garduñ ; o^b
• 关键词：Placenta accreta ; Embolisation ; Chemotherapy
• 刊名：Cirugía y Cirujanos (English Edition)
• 出版年：2017
• 出版时间：January-February 2017
• 年：2017
• 卷：85
• 期：1
• 页码：66-69
• 全文大小：911 K
• 卷排序：85

文摘

Placenta percreta may lead to massive obstetric haemorrhage, haemodynamic decompensation, and ultimately death. Total obstetric hysterectomy is universally accepted as treatment; however, the emergence of new techniques such as the uterine artery angioembolization approach, and the use of chemotherapy agents such as methotrexate, are alternatives also described in the literature.Clinical caseA 28 year-old patient, in her fourth gestation, with a previous history of 2 vaginal and 1 caesarean birth 4, in her 28.4 week of pregnancy, by second trimester ultrasound, was diagnosed with placenta percreta with bladder and rectal invasion using magnetic resonance imaging. Multidisciplinary and sequential treatment included: Caesarean with placenta in situ, uterine artery embolisation immediately after caesarean, chemotherapy with methotrexate weekly for 4 doses, and finally obstetric hysterectomy after bilateral hypogastric artery ligation. The outcome was favourable and the patient was discharged in good general condition.ConclusionsThe protocoled and sequential management including selective embolisation immediately after caesarean section with placenta in situ, weekly chemotherapy with methotrexate and obstetric hysterectomy, preceded by bilateral ligation of the hypogastric arteries, is a therapeutic alternative to be considered in cases of placenta percreta.