Sáez CVC, Arroyo DMJ, Averhoff HF

Language: Spanish
References: 15
Page: 1-10
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ABSTRACT

Introduction: Cesarean section and then hysterectomy is the main management of the placenta accreta, but several conservative alternatives are described, including leaving the placenta in situ and waiting for complete spontaneous reabsorption or expectant management.
Objective: To assess the expectant management of placenta accreta in a selected case.
Case report: A 34-year-old woman with history of two previous cesarean deliveries, was admitted with a diagnosis of placenta previa and suspected placental accreta. Signs of abnormal invasion were confirmed by two-dimensional ultrasound with color Doppler, cystoscopy reported taking of the bladder mucosa in the trigone and fundus area and nuclear magnetic resonance imaging reported invasion of the entire cervix, vaginal vault, and posterior wall of the bladder. She was assessed by a multidisciplinary team, expectant management was decided due to the complexity and risk of major bleeding. A cesarean section was performed at 36 weeks, the placenta was left in situ and, and as additional measures, surgical ligation of both hypogastric arteries and chemotherapy with methotrexate were performed. The patient evolved without complications and complete resorption of the placenta occurred after 149 days.
Conclusions: Leaving the placenta in situ is an alternative for the management of placenta accreta spectrum disorders. The choice of method requires a multidisciplinary risk-benefit assessment in relation to hysterectomy.

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