A Penance to Misdeed: A Case Report About Placenta Percreta

Abstract

Placenta percreta is a condition in which the placenta penetrates through the myometrium and into the uterine serosa. Sometimes it can be complicated by attachment to the surrounding structures or organs. The incidence of this condition is on the rise because of increased rates of cesarean sections. A 29-year-old gravida two, para one, living one with a previous cesarean section at 39 weeks of gestation was referred from a primary health center with complaints of leaking per vaginum for ten hours. She had no other associated symptoms. Her antenatal period was uneventful with all routine investigations within normal limits. A growth scan was done at 34 weeks of gestation. The scan was corresponding to the period of gestation with adequate liquor and placenta at fundoposterior location. A decision was taken to perform an emergency cesarean section in view of the previous cesarean section with premature rupture of membranes (PROM) and poor bishop score. After delivery of the baby when the placenta was tried to be removed, it could not be removed even with gentle traction. No plane of cleavage was identified between the uterine wall and placenta. The uterus was exteriorized and the placenta was found to have firmly adhered to the uterine wall and serosa on the fundal region. An intraoperative diagnosis of morbidly adherent placenta was made. A decision to perform an emergency obstetric hysterectomy was taken. A subtotal hysterectomy was done after counseling and necessary informed consent. Histopathology of the specimen was consistent with the findings of placenta percreta.

Keywords: bishop score; caesarean section; manual removal of placenta; placenta; placenta percreta.

Figure 1. Placenta seen fundoposteriorly invading the serosa

Figure 2. Microscopic examination of the specimen