The importance of a multidisciplinary approach to the delivery and subsequent management of patients with placenta increta

Background: Placenta increta is an abnormal partial or complete attachment of placental villi to the uterine wall. The main etiological factor of placenta increta is uterine traumatization, in particular during repeat caesarean sections or intrauterine surgical interventions. With a rise in the frequency of these operations, the prevalence of the pathology under consideration also increases by more than 10 times over the past 30 years. Undiagnosed placenta increta is associated with a high risk for massive blood loss and maternal mortality in delivery. Case report: The paper describes a clinical case of placenta increta first detected during caesarean section (a third childbirth). The delivery was complicated by uterine and urinary bladder rupture, ureteral traumatization, and massive blood loss. Hysterectomy and bladder wall defect suturing were done as vitally indicated. The early postoperative period was complicated by urinary peritonitis that made sanitation and drainage of the abdominal cavity and small pelvis, fistuloplasty and ureteral reimplantation to be performed. At 3 months when urine resumed to flow into the bladder, vesicovaginal fistula formation and microcystis were diagnosed due to dislocation of one of the nephrostomes. Cystectomy and orthotopic vesiculoplasty were electively carried out. An 8-month follow-up demonstrated improvements in general condition of the patient and her quality of life. Conclusion: Placenta increta increases the risk of life-threatening intra- and postoperative complications, which makes a multidisciplinary approach to preoperative preparation, perioperative management and delivery of the patients at high risk for placenta increta particularly important.

placenta increta, cesarean section, hysterectomy, vesicovaginal fistulas