The application of the management protocol of invasive placenta. A case report

R. Bohîlțea, M. Dumitrache, B. Ciontea, N. Turcan, T. Georgescu, I. Ducu, C. Oglavie, E. Dascălu, M. Cîrstoiu

Abstract: The incidence of adherent placenta has known a continuous ascendant incidence in the last decades. A correct management implies prenatal care and a careful planning of birth. We present the case of a 31-year-old G4P3, 37 weeks and 3 days’ gravida which presented herself at the emergency room, accusing unsteady painful low-intensity uterine contractions and asking for a cardiologic consult. The anamnesis revealed that this pregnancy was not properly monitored by a specialist and her medical history included two deliveries by caesarean section, a known untreated familial hypertrophic cardiomyopathy and a 36 weeks ultrasound scan describing a single fetus with a suspected cardiac hypertrophy and a praevia, anterior inserted placenta. In this context, the suspicion of an adherent placenta was confirmed by emergency ultrasound where a mild bladder invasion was observed. Due to the possibilities offered by an emergency medical hospital complete preparation for delivery was possible during one hour. A successful cesarean hysterectomy was performed, with the extraction of the fetus from transverse presentation trough vertical hysterotomy and rapid closing of the uterine incision after cutting the cord. The vezicotomy for uterine catheterization and excision of invaded submucosal area and subsequent hysterectomy were uncomplicated. Both mother and fetus presented a favorable prognosis. We present this case in the context of its complexity and the successful applied approach.
DOI:10.18643/gieu.2018.67

Keywords: adherent placenta, management, cesarean hysterectomy.