Placenta praevia percreta with initial bladder and parametrial invasion: a cause of life threatening hemorrhage after repeated cesarean section

Placenta percreta is a rare, but potentially life-threatening condition associated with high maternal mortality and morbidity rates, and caused by severe obstetric hemorrhage. Due to rising cesarean section rates, an increased incidence of different forms of adherent placentas (accreta, increta and percreta) has been observed. Although unsuspected during the antenatal period, diagnosis at the time of labor is usually secondary to the inability to define a cleavage plane. The associated hemorrhage can be substantial, and hysterectomy is frequently required. Definitive surgical management is the traditional treatment strategy; however, several authors have recently reported their experiences with conservative management, and some of them had success with this approach. We describe a case of massive, post-cesarean vaginal hemorrhage that occurred in the third postpartum period as the result of a misunderstood placenta percreta invading the parametria and bladder. Post-cesarean hysterectomy, bladder wall repair, and unilateral internal iliac artery ligation were performed to control massive intraoperative hemorrhage. There should be high rate of suspicion for placenta percreta with bladder and parametrium invasion in the evaluation of pregnant women with a history of Cesarean delivery and placenta previa at Cesarean section