aftermath of scarred uterus: placenta praevia accreta of different grades

ABSTRACT

There is a well-known association between repeated cesarean sections and placenta praevia accreta. Bladder invasion is a rare, advanced grade of this type of placenta that represents a tremendous hazard to both the mother and fetus. Two patients with placenta praevia accreta are reported here as well as general statistics of the incidence of placenta accreta at Kuwait's Maternity Hospital. One case, managed conservatively, had a good outcome, while the other case with placenta percreta invading the bladder died. Also included is a review of the literature with special emphasis on antenatal diagnosis, intra-operative and postoperative management. The treatment of such cases, varying from a conservative approach to a radical approach, is guided by the severity of placental involvement, the grade of placental invasion, and the clinical experience of the surgeon. In either approach, the aim is to control bleeding and maintain continuous support to the quickly depleting intravascular volume secondary to the profuse hemorrhage