Medical and surgical treatment of placenta percreta to optimize bladder preservation.

Abstract

Placenta percreta is associated with significant morbidity and mortality. Interventions are dictated by hemodynamic stability, desire to retain future fertility, and efforts to reduce surgical morbidity at time of delivery. Two cases of antenatally diagnosed placenta percreta with bladder invasion are presented. Conservative management was used, including endovascular interventions, leaving the placenta in situ, methotrexate, and delayed hysterectomy. Postoperative outcomes were acceptable, with no significant hemorrhagic complications or need for extensive bladder reconstruction. Antenatal diagnosis of placenta percreta with bladder invasion is essential in the multidisciplinary management of this potentially catastrophic condition. A comprehensive approach including delayed hysterectomy after medical management resulted in an excellent clinical outcome.