Perioperative management of undiagnosed placenta percreta: case report and management strategies

Chitra Sivasankar

Department of Anesthesiology, Guthrie Clinic, Sayre, PA, USA

Abstract: Placenta percreta is a rare pregnancy disorder in which the placenta penetrates the uterine myometrium and can invade surrounding organs. Because the rate of cesarean sections is increasing in developed countries, the incidence of placenta percreta is also rising. This condition significantly increases the risk of maternal and fetal morbidity and mortality, and is currently the most common indication for peripartum hysterectomy. Multidisciplinary management in a specialized center capable of providing massive transfusions can improve outcomes for the mother and baby. This team should include a surgeon specialized in pelvic surgery, an anesthesiologist experienced in obstetrics, a skilled urologist, a neonatologist, a blood bank team capable of administering multiple blood products, and an intensive care facility where the patient can be monitored. In this report, we present the case of a patient with preoperatively undiagnosed placenta percreta and discuss the relevant management methods. We also discuss the relevant obstetric and anesthetic management methods, as well as diagnostic and transfusion protocols.

Keywords: adherent placenta, accreta, peripartum hysterectomy, post-partum hemorrhage