Placenta percreta with iatrogenic megaureter: A maternal near miss case presentation

Conclusions A decision between radical and conservative strategies for placenta accreta must be made based on the degree of placental infiltration and other variables: the patient's hemodynamic status and her desire to remain fertile. In our opinion, cesarean hysterectomy remains the best therapeutic option to treat placenta percreta. Radical surgery should be done for poor availability of blood especially in rare blood types in other types of placenta accreta. Fullness in the retroperitoneal space should not be ligated except after excluding ureter dilatation and confirming hematoma by aspiration and disscetion. Megaureter may be gestational or pathological from ureteric ligation that is differentiated by hydronephrosis. Internal iliac artery ligation followed by cesarean hysterectomy with no trial of removal of placenta should be done to limit blood loss in placenta percreta. Fullness of bladder after repair should be washed as may be blood clot retention from bleeding. Megaureter could be presented intraoperative within minutes of ligation of the ureter and after hours by asymmetry between both kidneys regarding hydronephrosis. Bladder repair can be done by gynecologist but ureter ligation is better to be done by a urologist. Ureter identification should be considered before hysterectomy by visual assessment or dissection or proceeding with hysterectomy very close to cervix especially in total hysterectomy.
Source: Reviews in Vascular Medicine - Category: Cardiology Source Type: research