Placenta percreta presenting as an acute obstetric emergency in mid-second trimester: A case report

Abstract

Aim: To know the risks and management of placenta percreta in patients with previous lower segment cesarean section (LSCS) with postabortal hemorrhage. Background: Placenta percreta, a form of adherent placenta, is associated with significant postabortal hemorrhage often requiring emergency hysterectomy. Majority of these cases are seen in patients with a history of previous LSCS with anterior low-lying placenta. Case description: A 29-year-old female with previous two LSCS came at 19 weeks 4 days of gestational age with complaints of leaking per vaginum since 7 days and mild pain abdomen. Her ultrasonography showed single live intrauterine fetus (SLIUF) with anterior upper segment placenta with no evidence of accretion. She went into labor spontaneously and expelled a male baby weighing 300 gm. Subsequently, she had postabortal hemorrhage with the placenta in situ. Medical management of post-abortal hemorrhage (PAH) was given but she went into shock with massive blood loss. After stabilization of the patient with iv fluids and colloids, she was taken up for emergency laparotomy, in view of retained placenta with previous two LSCS with postabortal hemorrhage as medical management failed. On laparotomy, the placenta was anterior and was invading the wall of the uterus up to the serosa. As she was bleeding torrentially, an emergency hysterectomy was done without any delay in decision-making. She was transfused with four packed red blood cells (PRBC) and four fresh frozen plasma (FFPs). Her postoperative period was uneventful and she was discharged on day 7 in astable condition. Histopathological findings confirmed the absence of the placental basal plate and the presence of trophoblastic tissue in the myometrium and serosa. Conclusion: Good anticipation and timely decision are very important in decreasing maternal morbidity and mortality in cases of PPH with adherent placentas, like in other obstetric emergencies. Clinical significance: We wish to highlight the importance of good clinical knowledge with timely decision by OB/Gyn team in a patient with PPH and placenta percreta encountered in the mid-second trimester.