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A Two-Day Interventional Radiologic Approach to Invasive Placenta Percreta
Abstract Number: SUN-64
Abstract Type: Case Report/Case Series
Placenta percreta is a disorder involving abnormal invasion of the placenta through the myometrium and into surrounding structures. This case presents a multi-specialty two-day staged cesarean hysterectomy.
40 yoF G7P2042 presents for tertiary care due to expected placenta percreta with MRI findings of invasion into the bladder and peri-rectal space. Significant past surgical history of 2 prior CDs, 1 ectopic pregnancy, 3 SABs and 2 D&Cs. Multidisciplinary meeting held with radiology, gyn oncology, urology, anesthesia, MFM, and neonatology. Operative day 1 patient underwent occlusion balloon placement in bilateral internal iliac arteries under sedation, followed by CD under GA uneventfully. She was immediately brought back to IR for bilateral hypogastric gel-foam embolization, including other small feeding vessels. Operative day 2 started in IR with re-embolization of anterior divisions of internal iliac and bilateral occlusion balloons. She was then brought to OR for hysterectomy and cystotomy with repair leading to 4 L EBL and massive transfusion despite embolization and occlusion balloons. She was extubated POD 1 with stable course.
Despite multiple IR embolizations and balloon catheters, we still experienced a large hemorrhage intraoperatively. Without the help of embolization and staging, the likelihood of mortality is presumed high. This case highlights the importance of a multi-disciplinary team approach to reduce morbidity and mortality in these patients.
Leung TK, Au HK, Lin YH, Lee CM, Shen LK, Lee WH, Wang HJ, Hsiao WT, Chen YY.
Prophylactic trans-uterine embolization to reduce intraoperative blood loss for placenta percreta invading the urinary bladder. J Obstet Gynaecol Res. 2007 Oct;33:722-5.
Dubois J, Garel L, Grignon A, Lemay M, Leduc L. Placenta percreta: balloon occlusion and embolization of the internal iliac arteries to reduce intraoperative blood losses. Am J Obstet Gynecol. 1997 Mar; 176:723-6.
Ballas J, Hull AD, Saenz C, Warshak CR, Roberts AC, Resnik RR, Moore TR, Ramos GA. Preoperative intravascular balloon catheters and surgical outcomes in pregnancies complicated by placenta accreta: a management paradox. Am J Obstet Gynecol. 2012 Sep; 207:216.e1-5.