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

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

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

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

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

Placenta previa presents a highest risk to pregnancy, and placenta accreta is the most serious. Placenta accreta requires cesarean delivery and often results in massive obstetric hemorrhage and higher maternal morbidity. Challenges associated with cesarean delivery techniques may contribute to increased maternal blood loss and morbidity rates. Several recent obstetric studies reported the usefulness of transverse uterine fundal incision for managing placenta accreta. We present a case of placenta percreta that was treated by a transverse fundal incision. We successfully avoided cutting through the placenta and helped decrease maternal blood loss. After delivery, the patient underwent a cesarean hysterectomy. Postoperative day 48, she experienced watery discharge and was diagnosed with vaginal fistula. We present our case and review the literature.
Hemorrhage ; Humans ; Hysterectomy* ; Placenta ; Placenta Accreta* ; Placenta Previa ; Pregnancy ; Vaginal Fistula*

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

Uterine sacculation is a very rare complication associated with pregnancy in which a part of the uterine wall balloons, and it is difficult to diagnose because it is usually asymptomatic. It frequently contains the placenta and sometimes may be involved with the trapped placenta after delivery due to its structural characteristic. It is impossible to remove the retained placenta in the sac by using usual methods such as manual delivery or curettage so most of patients with it end up with having a laparotomy. Especially, if the placenta in it is accompanied by abnormal adherence of the placenta or serious hemorrhage, hysterectomy should be considered. Currently several conservative methods for the retained placenta including selective uterine artery embolization and administration of methotrexate have been introduced and these may be tried to treat the retained placenta in the uterine sacculation for avoiding operation and preserving future reproductive potential in selective cases. We experienced a case of placenta increta in the uterine sacculation that was diagnosed first during cesarian section and was treated with selective uterine artery embolization followed by methotrexate administration. This case is reported with a brief review of the literatures.
Curettage ; Hemorrhage ; Humans ; Hysterectomy ; Laparotomy ; Methotrexate ; Placenta Accreta* ; Placenta* ; Placenta, Retained ; Pregnancy ; Uterine Artery Embolization