Placenta percreta with bladder invasion in a previously scarred uterus. Case report
DOI:
https://doi.org/10.29166/rfcmq.v51i2.8631Keywords:
Placenta percreta, Hysterectomy, Urinary bladder diseases, Bladder invasionAbstract
Introduction: Placenta percreta with bladder invasion is an infrequent and severe complication. Timely diagnosis using imaging techniques is key to planning subsequent management and avoiding complications.
Objective: To describe the case of a patient with placenta percreta and bladder involvement, diagnosed in a timely manner, and to reflect on its multidisciplinary management.
Case presentation: A 45-year-old woman with a history of two previous cesarean deliveries and two spontaneous abortions. At 31 weeks and 4 days of gestation, Doppler ultrasound revealed multiple vascular lacunae and absence of the retroplacental plane. Magnetic resonance imaging confirmed an anterior placenta with focal myometrial loss, obliteration of the uterovesical plane, and probable bladder invasion. At 34 weeks and 3 days of gestation, a planned cesarean section was performed with fetal extraction through a high uterine incision and total hysterectomy with placenta in situ and partial bladder resection. The patient had a favorable postoperative course and was discharged on the fifth day. Discussion: Timely diagnosis allowed intervention by a multidisciplinary team, thereby preventing complications such as massive hemorrhage or urinary tract injury. The literature supports procedures such as hysterectomy with placenta in situ and partial bladder resection in advanced cases, in contrast to conservative approaches, which are considered unsafe in term pregnancies with a high risk of hemorrhage.
Conclusion: This case highlights the importance of ultrasound and magnetic resonance imaging as complementary studies for an individualized approach.
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Copyright (c) 2026 Francisco Rivadeneira Proaño, Jose Gregorio De Vicente Padrón, Melissa Mariam Sarzosa Alban
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