Abnormal attachment of the placenta (
Placenta accreta, increta, and percreta) is an uncommon but potentially lethal cause of maternal mortality from massive
postpartum hemorrhage. A 33-yr-old woman, who had been diagnosed with a
placenta previa, was referred at 30 weeks gestation. On ultrasound, a complete type of
placenta previa and multiple intraplacental lacunae, suggestive of
placenta accreta, were noted. For further evaluation of the placenta, pelvis MRI was performed and revealed findings suspicious of a
placenta increta. An elective cesarean delivery and subsequent
hysterectomy were planned for the patient at 38 weeks gestation. On the day of delivery, endovascular
catheters for balloon occlusion were placed within the hypogastric arteries, prior to the
cesarean section. In the operating room, immediately after the delivery of the baby, bilateral hypogastric arteries were occluded by inflation of the balloons in the
catheters previously placed within. With the
placenta retained within the uterus, a total
hysterectomy was performed in the usual fashion. The occluding balloons were deflated after closure of the vaginal cuff with hemostasis. The patient had stable vital signs and normal laboratory findings during the recovery period; she was discharged six days after delivery without complications. The final pathology confirmed a
placenta increta.