Anterior and posterior Placenta previa percreta in blood group 0 negative patient with urologic complications: An interesting maternal near miss case presentation

Conclusions A decision between radical and conservative strategies for placenta increta and percreta must be made based on the degree of placental infiltration (whether it goes beyond the perimetrium and into adjacent organs) and other variables: the patient’ s hemodynamic status and her desire to remain fertile. In our opinion, cesarean hysterectomy when the perimetrium is intact remains the best therapeutic option to treat placenta increta and percreta. If, however, placental invasion largely exceeds the perimetrium and/or the patient wishes to remain fertile, management of the placenta in situ is indicated, with full knowledge of the risks of major hemorrhaging and severe infection. radical surgery should be done for poor availability of blood especially in rare blood types. Fullness in the retroperitoneal space should not be ligated except after excluding ureter dilatation and confirming hematoma. Megaureter may be gestational or pathological from ureteric ligation that might be differentiated by hydronephrosis. Iliac ligation followed by cesarean hysterectomy with no trial of removal of placenta should be done to limit blood loss.fullness of bladder after repair should be washed as may be blood clot retention from the uterine and placental bleeding.megaureter could be presented intraoperative within minutes of ligation of the ureter.
Source: Reviews in Vascular Medicine - Category: Cardiology Source Type: research