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      Placenta percreta con invasión a vejiga y a uréteres. Reporte de un caso


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          Se describe un caso de acretismo placentario en una paciente de 24 años de edad, 3 gestas, 2 cesáreas, quien consultó por sangrado de color rojo rutilante en abundante cantidad. Posterior al examen físico de ingreso se realiza el diagnóstico de placenta previa oclusiva parcial. Durante la cesárea se observó la invasión del peritoneo por la placenta y la fuerte fijación de ésta a la vejiga y a la porción inferior del uréter derecho. Se realizó histerectomía subtotal y ureterocistotomía.

          Translated abstract

          A case of acretism placentae is described in a 24 years-old patient, 3 gravida, 2 cesarean, who consulted for abundant red brilliant hemorrhage. After physical examination a diagnosis of partial occlusive placenta previa was done. During cesarean section invasion of peritoneum by placenta and strong fixation of it to bladder was observed. Sub-total hysterectomy and uterocistectomy was performed.

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          The management of placenta percreta: conservative and operative strategies.

          Our purpose was to assess preferences for the management of placenta percreta and identify aspects of care related to an improved outcome. Both an analysis of a questionnaire issued to members of the Society of Perinatal Obstetricians and a retrospective study at our institution were used to obtain case histories of women with placenta percreta during a recent 3-year period. Fifty-five of the 109 cases (50%) reported by members of the Society of Perinatal Obstetricians were suspected ante partum. Complications associated with this disorder included uterine rupture (3 cases), transfusion of > 10 units (44 cases, 40%), ureteral ligation or fistula formation (5 cases each, 5%), infection (31 cases, 28%), perinatal death (10 cases, 9%), and maternal death (8 cases, 7%). Management options included surgical removal of the uterus and involved tissues (101 cases, 93%) and conservative treatment with the placenta left in situ after delivery (8 cases, 7%). More members of the Society of Perinatal Obstetricians responding to our survey opted for conservative management if adjacent tissues were involved (69% with extension into the bladder or gastrointestinal tract) compared with 31% when the percreta was confined to the uterus, p < 0.001. Conservative therapy was also associated with less blood loss in reported cases (median units red blood cells transfused, 0 vs 7, p = 0.003). Two of the three cases of placenta percreta at our institution were identified ante partum. The third case represents the first reported with antepartum identification of percreta followed by deliberate conservative treatment. With greater involvement of surrounding tissues, conservative treatment was preferred in hemodynamically stable patients. If surgical excision of the placenta is attempted or necessary, physicians experienced in pelvic dissection must be involved because of the frequency of maternal morbidity and mortality.
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            Modified cesarean hysterectomy for placenta previa percreta with bladder invasion: retrovesical lower uterine segment bypass.

            M Pelosi (1999)
            Present conservative and radical surgical management of placenta previa percreta with bladder invasion is associated with significant hemorrhage and the need for blood salvage, transfusion, and component therapy. Conventional cesarean hysterectomy strategies have high surgical morbidity, despite adequate personnel and resources.
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              Placenta percreta with bladder invasion managed by arterial embolization and manual removal after cesarean.


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                Revista de Obstetricia y Ginecología de Venezuela
                Rev Obstet Ginecol Venez
                Sociedad de Obstetricia y Ginecología de Venezuela (Caracas )
                June 2007
                : 67
                : 2
                : 127-130
                [1 ] Servicio de Obstetricia y Ginecología



                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0048-7732&lng=en

                Obstetrics & Gynecology
                Placenta percreta.,Bladder,Ureters,Placenta percreta,Vejiga,Uréteres
                Obstetrics & Gynecology
                Placenta percreta., Bladder, Ureters, Placenta percreta, Vejiga, Uréteres


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