PURPOSE: To report the use of embolotherapy to avoid hysterectomy in rare placenta percreta. CASE REPORT: A pregnant 34-year-old woman (gravida 3, para 2) was admitted with premature rupture of membranes and vaginal bleeding in the 32nd week. Prenatal B-mode and Doppler ultrasound revealed marked hypervascularity of the placenta with disruption of the uterine-bladder interface consistent with placenta percreta. Since the patient insisted on uterine preservation, uterus and placenta were left in situ after caesarean section, which was followed by coaxial microcoil embolization of 6 pelvic arteries and postoperative methotrexate administration. Three months later, the patient had severe bleeding from the retained placenta, possibly under the influence of anticoagulation administered for pulmonary embolism. Emergent hysterectomy was performed. CONCLUSIONS: Coil embolization may avoid immediate hysterectomy and reduce peri-delivery blood loss in placenta percreta. However, retained placenta poses a serious risk, even after months, and secondary hysterectomy should be performed as an elective procedure after embolization.
PURPOSE: To report the use of embolotherapy to avoid hysterectomy in rare placenta percreta. CASE REPORT: A pregnant 34-year-old woman (gravida 3, para 2) was admitted with premature rupture of membranes and vaginal bleeding in the 32nd week. Prenatal B-mode and Doppler ultrasound revealed marked hypervascularity of the placenta with disruption of the uterine-bladder interface consistent with placenta percreta. Since the patient insisted on uterine preservation, uterus and placenta were left in situ after caesarean section, which was followed by coaxial microcoil embolization of 6 pelvic arteries and postoperative methotrexate administration. Three months later, the patient had severe bleeding from the retained placenta, possibly under the influence of anticoagulation administered for pulmonary embolism. Emergent hysterectomy was performed. CONCLUSIONS: Coil embolization may avoid immediate hysterectomy and reduce peri-delivery blood loss in placenta percreta. However, retained placenta poses a serious risk, even after months, and secondary hysterectomy should be performed as an elective procedure after embolization.
Authors: Charlotte N Steins Bisschop; Timme P Schaap; Tatjana E Vogelvang; Piet C Scholten Journal: Arch Gynecol Obstet Date: 2011-06-03 Impact factor: 2.344