Case report: placenta percreta with bladder invasion

Abstract

Objective: To report the case of a patient with only one previous cesarean who was diagnosed with placenta previa and percreta, with bladder invasion and, despite the severity of the case, presented a good evolution. Case details: Pregnant woman, 37 years old, with a history of one cesarean. Referred at 37 weeks and 3 days for termination of pregnancy due to total placenta previa and placental accreta. During surgery, intense vascularization of the anterior uterine wall was identified with placental invasion of the bladder, which confirmed the intraoperative diagnosis of placenta percreta. After hysterotomy, the newborn was delivered to the pediatrician in good condition. The patient then presented massive bleeding with difficulty in hemostasis. Without placental delivery, subtotal hysterectomy was initiated. There was extensive bladder injury, close to the insertion of the ureters and bilateral ureteral catheterization and cystorrhaphy were performed. The patient received intensive care and, after clinical stability, was discharged with an indwelling urinary catheter that was later removed. The anatomopathological examination confirmed placenta accreta. Final considerations: Strict surgical planning is necessary in cases of placenta percreta to reduce maternal and neonatal morbidity and mortality.