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Case Reports in Obstetrics and Gynecology
Volume 2013, Article ID 702067, 3 pages
http://dx.doi.org/10.1155/2013/702067
Case Report

Placenta Previa Percreta: A Case Report of Successful Management via Conservative Surgery

S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, 06132 Perugia, Italy

Received 24 October 2012; Accepted 6 December 2012

Academic Editors: Y. Ezra, A. Kofinas, and M. G. Porpora

Copyright © 2013 Silvia Canonico et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Placenta percreta is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. We present a case of placenta previa percreta diagnosed by ultrasound and magnetic resonance imaging techniques, in which we accomplished conservative management of postpartum hemorrhage. The management we propose includes the following steps: preventive catheterization of the descending aorta via transhumeral access; Stark cesarean delivery; uterotonics drugs; Affronti endouterine square hemostatic sutures; intrauterine application of Bakri balloon and partial filling with 100 mL of normal saline; B Lynch suture, hysterorrhaphy, and filling a Bakri balloon with up to 500 mL of normal saline; reversible radiological embolization; and/or surgical ligation of the uterine arteries. The bleeding stopped following placement of Affronti sutures combined with external (B-Lynch suture) and internal (Bakri balloon) uterine compression. Our experience indicates that this conservative method can be considered an option in the management of selected cases of pregnancy at high risk for intrapartum hemorrhage.