Background: The contemporary obstetrician is increasingly put to the test by rising numbers of pregnancies with morbidly adherent placenta. This study illustrates our experience with prophylactic bilateral internal iliac artery occlusion as part of its management. Methods: Between January 2011 to January 2014, 13 consecutive patients received the intervention prior to scheduled caesarean delivery for placenta accreta. All cases were diagnosed by ultrasonography, color Doppler imaging and supplemented with MRI where necessary. The Wanda balloonTM catheter (Boston Scientific, Natick, MA, U.S.A) were placed in the proximal segment of the internal iliac arteries preceding surgery. This was followed by a midline laparotomy and classical caesarean section, avoiding the placenta. Both internal iliac balloons were inflated just before the delivery of fetus and deflated once haemostasis was secured. Primary outcomes measured were perioperative blood loss, blood transfusion requirement and the need for ICU admission. Results: The mean and median intraoperative blood loss were 1076mls±707 and 800mls (300-2500) respectively while mean perioperative blood loss was 1261mls±946. Just over half of the patients in our series required blood and/or blood products transfusion. Two patients (15.4%) required ICU admission. Conclusion: Our study suggests that preoperative prophylactic balloon occlusion of bilateral internal iliac arteries reduces both blood loss and transfusion requirement in patients with placenta accreta, scheduled to undergo elective caesarean hysterectomy. It is an adjunct to be considered in the management of a modern day obstetric problem, although the authors are cautious about generalizing its benefit without larger, randomized trials.
Placenta Accreta

Placenta accreta syndrome results from the abnormal adherence of the placenta to the myometrium due to the absence of the decidua basalis and imperfect development of the Nitabuch layer. It causes serious obstetric morbidity due to the risk of massive hemorrhage. Balloon occlusion of internal iliac arteries has been used prophylactically to decrease hemorrhage in cesarean hysterectomy for placenta accreta. In this paper, two cases of placenta accreta syndromes wherein bilateral internal iliac artery balloon occlusion was done prior to cesarean hysterectomy are presented. Case 1 is a 50-year-old G4P0 (0030) pregnancy uterine who came in at 33 3/7 weeks age of gestation for fetal surveillance. Case 2 is a 38-year-old G4P2 (2012) pregnancy uterine who came in at 33 4/7 weeks age of gestation for decreased fetal movement. Both cases were successfully delivered via cesarean hysterectomy with prophylactic balloon occlusion under a multidisciplinary team in a tertiary care center.
Balloon Occlusion ; Placenta Accreta

Placenta accreta syndrome (PAS) is rare in first-trimester abortions with an unscarred uterus. It is this rarity that makes diagnosis and management difficult and challenging. This is a case report of a multigravid with an early incomplete abortion complicated by PAS (placenta increta) manifesting as an ill-defined hypervascular uterine cavity mass on transvaginal ultrasound, with decreasing trends of serum beta-human chorionic gonadotropin. PAS was successfully diagnosed preoperatively, and an uneventful hysterectomy was performed. A curettage that could potentially lead to catastrophic hemorrhage was prevented. This case highlights the diagnostic dilemma in early trimester PAS, the importance of early accurate diagnosis, and a good correlation with ancillary diagnostics to provide prompt and appropriate management.
Pregnancy ; Placenta Accreta ; Ultrasonography, Doppler, Color

Placenta accreta is a rare condition and is associated with considerable maternal morbidity and mortality. Though hysterectomy is a definitive therapy, there are some occasions that conservation of the uterus is desired by the patient and bleeding is not excessive. We report a case successfully treated using methotrexate in patient whose placenta was not detached from the uterus with a brief review of literature.
Hemorrhage ; Humans ; Hysterectomy ; Methotrexate* ; Mortality ; Placenta Accreta* ; Placenta* ; Uterus

Angular pregnancy is rare, in which the embryo in the lateral angle of uterine cavity and located medial to the utero-tubal junction. Angular pregnancy is differentiated from interstitial pregnancy. There is no report about term angular pregnancy in Republic of Korea, a few reports in other countries. Angular pregnancy has different clinical characteristics according to the trimester. We diagnosed angular pregnancy by ultrasonography and computed tomography (CT). The CT is a useful diagnostic method. We report a case of term angular pregnancy with placenta accreta and review the diagnostic process and complications.
Embryonic Structures ; Placenta ; Placenta Accreta ; Pregnancy ; Republic of Korea

Cesarean Section ; Female ; Humans ; Hysterectomy ; Placenta Accreta ; Placenta Previa ; Pregnancy

Cesarean Section ; Female ; Humans ; Placenta Accreta ; Placenta Previa ; Pregnancy

Placenta accreta is one of the most feared complications among gravid women, as it is associated with massive and potentially life-threatening intrapartum and postpartum hemorrhage. Due to its natural history, placenta accreta is only naturally seen or expected as a cause of bleeding only among obstetric patients. This case report describes a rare manifestation of profuse abnormal uterine bleeding secondary to a placenta accreta in a non-gravid patient. The non-pregnant state was evidenced by the absence of history of amenorrhea and pregnancy signs and symptoms, a negative urine pregnancy test and normal serum bhcg results. A diagnosis of placenta accreta was mainly based on a post-hysterectomy histopathological examination. Theoretical explanations to explain this phenomenon is discussed in this case report.
Pregnancy ; Female ; Placenta Accreta ; Uterine Diseases ; Uterine Hemorrhage

Placenta accreta is a rare but potentially lethal obstetric emergency due to massive hemorrhage, uterine perforation, and infection. Traditionally, hysterectomy was performed in the occurrence of serious hemorrhage. Currently, several conservative treatments including the use of uterine packing, leaving the placenta in situ, argon-beam coagulation, uterine artery ligation, administration of methotrexate, and uterine artery embolizations are introduced to preserve future reproductive potential. We present a patient with placenta accreta treated successfully with selective uterine artery embolization followed by methotrexate with brief review of literature.
Emergencies ; Hemorrhage ; Humans ; Hysterectomy ; Ligation ; Methotrexate* ; Placenta Accreta* ; Placenta* ; Uterine Artery Embolization* ; Uterine Artery* ; Uterine Hemorrhage

Placenta previa percreta is an uncommon and lifetbreatening complication of pregnancy. tbe incidence of both placenta previa and placenta acaeta are increased in patients with scaned uteri, and patienth with uterine scars and placenta previa are at inaeased risk for also baving placenta accreta. A case of placents previa percreta involving the urinary bladder was experienced and treated with surgical management. We reported a case with concerned literatures
Cicatrix ; Humans ; Incidence ; Placenta Accreta* ; Placenta Previa ; Placenta* ; Pregnancy ; Urinary Bladder* ; Uterus