When Placentas Attack

Proposal Number:


Proposal Type:

Medically Challenging Case Report Poster 


Shradha Khadge  
Mount Sinai Hospital


Chantal Pyram-Vincent  
Mount Sinai


36 year-old female G4P3003 (3 prior low transverse C/S) at 38w4d presented to L&D contracting, scheduled for cesarean section at 39 wks. Pt had weekly ultrasounds, revealing an anterior placenta. Although patient contracting, cervix closed on exam. Pt was NPO 6 hrs. The anesthetic plan included a combined spinal-epidural anesthesia, 2 large bore IVs, an active type and cross with 2U pRBCs in the OR, standard ASA monitors and a foley catheter. When incision was made, the subcutaneous tissue, fascia, rectus, and peritoneum were densely adherent. Upon further dissection, large vessels were visualized protruding to the surface of the anterior uterine wall with no overlying myometrium, suspicious for placenta percreta. Help was immediately called and the anesthetic plan was re-evaluated.

Professional Category:



Critical Care

Supporting Image: Percreta.jpg
   ·Superior view of anterior placental invasion. Newly formed vessels are present between posterior bladder wall and the abnormal placental invasion (black arrows) is evident. BL, bladder

Enter up to two references.

1. Palacios‐Jaraquemada JM. One‐step conservative surgery for abnormal invasive placenta (placenta accreta–increta–percreta). Section 5: Placental abnormalities. In A Comprehensive Textbook of Postpartum Hemorrhage: An Essential Clinical Reference for Effective Management ( 2nd edn). Sapiens Publishing: London, 2012; 263– 274.