PLACENTA PERCRETA NECESSITATING HYSTERECTOMY: A RARE CASE REPORT

Dr. Twinkle Sood*

ABSTRACT

Disorders of placental invasion is an umbrella term which encompasses three different disorders: placenta accreta, increta and percreta depending upon the extent of invasion into the uterus. They are an important cause of severe maternal and foetal morbidity and mortality. As the incidence of caesarean section is on the rise so is the incidence of these disorders. The incidence of placental invasion disorders is variable ranging from 1:540 to 1:93000. Placenta percreta is a rare complication of pregnancy associated with significant postpartum hemorrhage often requiring emergency hysterectomy. Majority of these cases are seen in patients with history of previous caesarean section with anterior low lying placenta. I report a case of 34 year G3P2+0(L2) who presented to the emergency at 24 weeks of gestation with the chief complaint of bleeding per vaginum with low lying placenta and history of previous two lower segment caesarean section (LSCS). On examination the patient was haemodynamically unstable and ultrasonography revealed low lying placenta with features suggestive of placental invasion. Emergency hysterotomy was performed with extraction a dead female child with weight 620 grams. Intraoperatively there was evidence of placenta percreta with uncontrolled haemorrhage; hence hysterectomy was performed. This case report highlights the presenting features, complications, early diagnosis and management of placental invasion anomalies to reduce the maternal and foetal morbidity and mortality.

Keywords: Placenta percreta, pregnancy, lower segment caesarean section, low lying placenta, hysterectomy.