Placenta percreta with bladder invasion: a delimma

ABSTRACT

Placenta percreta occurs in 5-7% of all abnormal placentations. Around 50% of women diagnosed with placenta previa having two or more cesarean sections develop placenta accreta or percreta. Here we present a case of 22 years old female who presented with 36 weeks of pregnancy having anemia and placenta previa type IV. She was planned for elective cesarean section due to placenta previa and previous two cesarean sections. She was operated by a senior gynaecologist. Placenta was found to be densely adherent with the uterine wall and was invading the bladder. Fifty percent of the placenta expelled out spontaneously and remaining 50% was removed in piece meal carefully. Haemostatic sutures were taken on the bladder wall. Massive haemorrhage was observed and the patient went into shock. Urologist was called as the bladder was densely adherent with the lower segment. Cesarean hysterectomy was done but oozing from stitch line continued so bilateral Internal Iliac Artery ligation was performed