Placenta percreta: a rare catastrophe

ABSTRACT

To document the clinical presentation, risk factors, management and management of placenta percreta. Case series. A 5 year study from January 2001 to December 2005 in Gynaecology and Obstetrics department, Unit II, Jinnah Postgraduate Medical Centre, Karachi. This study included patients of placenta percreta who were either diagnosed on ultrasound during antenatal period or accidentally found at exploratory laparotomy or caesarean section. A total of 11 cases of placenta percreta were managed during the study period. The frequency of the lesion was 1 2058 deliveries. In 7 patients placenta had invaded and perforated the uterine wall, in 3 patients it had invaded the urinary bladder as well and in one patient there was broad ligament invasion. Most common risk factors were previous caesarean section [CS] in 91 percent cases and placenta previa [91 percent] followed by curettage [9 percent]. Hysterectomy was performed in all patients. Partial cystectomy and bladder repair was done in those cases where urinary bladder was invaded. Urinary bladder injury occurred in two [27.27 percent] patients. Two patients died, one due to irreversible shock and other due to acute renal failure. Placenta percreta is a rare catastrophe associated with high maternal morbidity and mortality. Early diagnosis and surgery following adequate resuscitation should be accomplished with multidisciplinary team