Professional paper

Multidisciplinary approach in the management of pregnancy with placenta accreta spectrum disorder - Case report

Zdeslav Benzon ; University Hospital Split, Department of Obstetric and Gynecology, Split, Croatia
Marko Jukić ; University Hospital Split, Department of Obstetric and Gynecology, Split, Croatia
Mate Perković ; University Hospital Split, Department of Anesthesiology, Split, Croatia
Liana Cambj Sapunar ; University Hospital Split, Department of Radiology, Split, Croatia
Marijan Šitum ; University Hospital Split, Department of Obstetric and Urology, Split, Croatia
Sandra Benzon ; University Hospital Split, Department of Obstetric and Gynecology, Split, Croatia

Abstract

From the histopathologic perspective Placenta accreta spectrum (PAS) shows the absence of the normal intervening decidua and invasion of the placenta into the myometrium. There is placenta accreta with the chorionic villi attach directly to the surface of the myometrium in the absence of the decidual layer and placenta increta when the chorionic villi penetrate deeply into the myometrium reaching the external layer. There is also placenta percreta where the invasive chorionic villi reach and penetrate through the myometrium to uterine serosa and it is nowadays the most common reason for peripartum hysterectomy (1). Drawing the line between these subtypes is not always easy, especially in the clinical situations when the invasiveness of the placenta is not known before the delivery (2). The maternal and fetal outcomes are improved upon appropriate antepartum diagnosis and care by multidisciplinary experts with experience in PAS treatment (3). Here we present a pregnancy and multidisciplinary delivery management of a 40-year-old female, gravida V, para IV, with history of the three cesarean sections, in 36+2 weeks of gestation in a tertiary academic teaching hospital. We confirmed suspected PAS antenatally based on ultrasound and magnetic resonance imaging (MRI). Preoperative preparation included the ensuring of blood products availability, the use of arterial occlusion balloons to reduce hemorrhage, and the use of double JJ stent to prevent ureteral injuries. We performed a cesarean section with immediate uterine amputation due to severe bleeding, after which the patient fully recovered. If PAS timely suspected and confirmed intraoperatively, the best maternal and neonatal outcome is achieved by the multidisciplinary approach that enables adequate elective procedure.

Keywords

placenta percreta; cesarean section; hemorrhage; hysterectomy

Hrčak ID:

263220

URI

https://hrcak.srce.hr/263220

Publication date:

6.10.2021.

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