Rare Placenta Percreta Surgery at Niloufer Saves Mother, Newborn

Hyderabad: A 35-year-old woman facing a life-threatening pregnancy complication successfully underwent a rare and intricate surgery at Niloufer Hospital, which saved both her and her premature baby. She was 27 weeks into her pregnancy at the time of the procedure.

The woman, who is from Vikarabad, was admitted to the hospital on February 1 after being referred from a private health facility because of excessive bleeding. The doctors diagnosed her with G4 placenta percreta with bladder invasion, a critical condition where the placenta invades the uterine wall deeply and reaches the bladder, endangering the life of the mother.

On February 10, a team of specialists performed an elective Cesarean section along with a complex bladder repair surgery. The woman delivered a premature baby boy weighing just one kilogram, who is currently under medical care in the Neonatal Intensive Care Unit (NICU).

A joint operation between the gynecologists and urologists at the hospital ensured that the bladder was successfully repaired. The condition of the mother has been confirmed by medical experts to be stable after the operation.

State Health Minister Damodar Rajanarsimha praised the medical team of the hospital, including Superintendent Dr. Ravi Kumar, for their remarkable efforts in managing this difficult case.

Understanding Placenta Percreta: A Rare but Serious Pregnancy Complication

Placenta percreta is the most serious and rare type of placenta accreta, usually extending to adjacent organs like the urinary bladder. Placenta percreta is a serious condition because it has the potential to cause massive bleeding, and hence it is a life-threatening pregnancy complication. Although it is often diagnosed during delivery, it can be detected early by imaging modalities like ultrasound, magnetic resonance imaging (MRI), or cystoscopy. ^[1]

To reduce blood loss, physicians usually refrain from trying to remove the placenta during delivery. Instead, they might choose a hysterectomy or, in certain situations, methotrexate therapy to dissolve any remaining placental tissue after giving birth. In case of severe bleeding, however, an urgent surgical procedure, including the removal of the uterus, might be required. In worse situations where the placenta has invaded the bladder deeply, the surgeons might be required to remove the affected organ partially or reconstruct it.

Excessive bleeding during childbirth remains one of the leading causes of maternal illness and mortality. In rare instances, life-threatening hemorrhages can result from the placenta abnormally growing into the bladder. Retained placental tissue contributes to approximately 5–10% of postpartum hemorrhage cases. Normally, a protective layer known as the decidua separates the placental tissue from the uterine wall (myometrium). But in placenta accreta, this layer is absent, and the placenta attaches directly to the uterus, risking excessive bleeding at delivery.

Placenta accreta is classified according to the degree of its invasion into the uterine wall:

• Placenta accreta vera: The placental tissue adheres superficially to the myometrium.

• Placenta increta: The placenta invades further into the myometrium but not all the way through it.

• Placenta percreta: The most extreme form, in which the placental tissue completely invades the myometrium and can extend into contiguous organs, such as the bladder or rectum.

Though the exact etiology of placenta accreta remains elusive, several risk factors are recognized. Among them are history of cesarean sections, placenta previa, multigravidia, a history of prior uterine interventions like curettage, and Asherman syndrome, or a condition wherein scarring develops in the interior of the uterus. Knowledge about such risk factors as well as prompt diagnosis goes a long way towards enhancing maternal as well as fetal outcomes.^[1]

References:

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC2777065/

(Input from various sources)

(Rehash/Sai Sindhuja K/MSM)

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