Optimizing outcome of cesarean hysterectomy by performing placental imaging: a case report

Abnormal placental invasion in pregnancy is one of the most important dilemmas in gynecology and obstetrics medicine and because of the high potential risk of life-threatening massive bleeding, it has been considered as one of the most important causes of maternal morbidity and even mortality. According to the fact that previous cesarean section is the most highlighted and well-known risk factors for developing these types of abnormal placental invasion, and despite comprehensive recommendations for decreeing of this kind of surgery, the rate of caesarian delivery is raising worldwide, detecting the safer methods of management for optimizing the outcome is mandatory.

In this report, we are discussing a patient in Firoozgar Hospital, Tehran, Iran, with twin pregnancy accompanying with placenta previa with abnormal invasion, which has got the best possible outcome after performing a multidisciplinary approach without any need to blood transfusion or general anesthesia during cesarean hysterectomy as the standard management of placenta increate. In this case, we have performed magnetic resonance imaging (MRI) before surgery. We found out that we can use the exact site of placental margin and the distance between placental margin and uterovesical junction. So we have done the uterine incision horizontally without damaging to the placenta. Generally, Doppler ultrasonography has enough accuracy for detecting all kinds of placenta creates.

By selecting a safe uterine incision, we can prevent such a sudden and massive bleeding during the operation and also avoid occurring end-organ damage due to hemorrhage for instance, acute tubular necrosis, disseminated intravascular coagulation resulted in maternal morbidity and mortality. In this report, we also discuss the points needed for management and treatment of abnormal placental invasion by reviewing the recent literatures.