///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-06:00

A Two-Day Interventional Radiologic Approach to Invasive Placenta Percreta

Abstract Number: SUN-64
Abstract Type: Case Report/Case Series

Brandon M Lopez MD1


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.


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SOAP 2017