Antenatal diagnostic aspects of placenta percreta and its influence on the perinatal outcome: a clinical case and literature review

Abstract

Background: Placenta percreta is a very rare, but extremely life-threatening obstetrical pathology for the mother and the child, especially in the cases when it is not diagnosed before the birth and when it results in massive bleeding and a dramatic deterioration of condition. It is extremely important to diagnose this pathology as early as possible and plan further optimal care of patients in order to minimize life-threatening complications.

Case report: The paper presents an illustrated clinical case of placenta percreta determined before the birth. Features of visual diagnostics are discussed. A 32-year-old pregnant woman with a history of two caesarean deliveries arrived at the tertiary level hospital at 22 weeks of gestation due to abdomen pain. Placenta previa was diagnosed and ultrasound, magnetic resonance imaging suggesting placenta percreta were seen. On the 32nd week, the planned caesarean hysterectomy was performed. The balloon catheters to occlude the internal iliac arteries and minimize bleeding during the surgery were used.

Conclusions: Antenatal diagnosis of placenta percreta is especially important. Methods of visual diagnostics are complementary. The optimal surgical approach during caesarean hysterectomy remains controversial. In the case of the slow oozing without a clearly identified source of bleeding after hysterectomy and internal iliac arteries balloons deflation, ligation of one of the internal iliac arteriescan be reasonable to avoid residual haemorrhage and relaparotomy.

Keywords: antenatal diagnostics; placenta percreta; placenta previa; visual diagnostics.

Fig. 1.

An ultrasound image in greyscale mode. Abdominal probe. Placenta (P) on the anterior wall covers the uterine scar area and overlies the endocervical os. The boundary between myometrium and the placenta is not clear, the deformation of the uterine wall near the bladder (B) is observed. Lacunar spaces (L) of various size and irregular are present in the placenta

Fig. 2.

An ultrasound image in Doppler mode. Abdominal probe. Lacunar spaces (L) of various size and irregular are present in the placenta (P). The posterior wall of the bladder (B) is convex. An active heterogeneous blood flow (V) is observed near the bladder and in the placenta

Fig. 3.

An ultrasound image in Doppler mode. Transvaginal probe. Lacunar spaces (L) of various size and irregular are present in the placenta (P). The posterior wall of the bladder (B) is convex. An active heterogeneous blood flow (V) is observed near the bladder and in the placenta

Fig. 4.

Sagittal T2-weighted MR images. The upper wall of the bladder (B) is locally deformed from the left to 35 mm in length, contact and pressing (arrow) from the side of the placenta (P) is visible, in some places the wall contour of the bladder of the normal signal is clearly differentiated and hypervascular, inadequate myometrium (M)

Fig. 5.

Coronal T2-weighted MR images. The upper wall of the bladder (B) is locally deformed from the left to 35 mm in length, contact and pressing (arrow) from the side of the placenta (P) is visible, in some places the wall contour of the bladder of the normal signal is clearly differentiated and hypervascular, inadequate myometrium (M)

Fig. 6.

A cystoscopy image. Local redness of the bladder mucosa

Fig. 7.

The uterus with placenta percreta. A longitudinal incision (I) in the corporal area (C). The uterus is deformed due to placenta percreta (P), the walls are thinner and stretched