Modified cesarean hysterectomy for placenta previa percreta with bladder invasion: Retrovesical lower uterine segment bypass

Background: 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. Case: A 37-year-old, gravida 3, para 2-0-0-2, with a radiographic diagnosis of placenta previa percreta with bladder invasion, and confirmed fetal lung maturity, had a modified cesarean hysterectomy at 34 weeks' gestation. The bladder was partially mobilized beneath the percreta invasion site via the paravesical spaces. Estimated blood loss was 900 mL. Superficial placental bladder invasion was confirmed by pathology. The postoperative course was uneventful. Conclusion: Modified cesarean hysterectomy prevented hemorrhage and need for blood salvage, transfusion, or component therapy in managing a case of placenta previa percreta with bladder invasion. (Obstet Gynecol 1999;93: 830-3. (C) 1999 by The American College of Obstetricians and Gynecologists.).