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Placenta percretaFrom: Karen Robertson (robertka@waikatodhb.govt.nz)Thu Jul 31 18:44:57 2003
Dear Colleagues, I am a sonographer working at Waikato Hospital in Hamilton, NZ. I am currently involved with a tricky case here with a hospital staff member (isn't it always)! She is a G4P3 lady with 2 prior c-sections, in her most recent pregnancy it became apparent very early on that she had a grade4 placenta praevia with increasing (as the term progressed) evidence of placenta increta/percreta. She wanted conservative management with a uterine sparing procedure so babe was delivered by classical c-section at 36 weeks and the placenta was left in situ. The next day she came for uterine embolisation with a view to shutting down placental function, one uterine vessel was successfully embolised using coils, the other uterine artery was described as rudimentary only and was therefore not embolised. Immediately post embolectomy ultrasound showed placental vascularity was reduced with a small amount of echogenic fluid seen superiorly within the uterus. Subsequently ultrasound every 3-4 days have shown increasing vascularity of placenta with an increase in the amount of fluid within the cavity. Vessels appear to indent the posterior wall of the bladder and there is no appreciable myometrium between the placenta/bladder interface. We need to have a plan should she haemorrhage and an MRI was attempted with a view to assessing degree of bladder invasion but had to be abandoned due to metallic coils from the recent embolisation. Should we attempt another embolisation? What experience have the forum members had with Methotrexate? Does anyone have any suggestions at this point - all information would be gladly received as this is the first time we have had such a case here. Thanking you in anticipation...... Karen.
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