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Postpartum Management of Placenta Previa Accreta Left In Situ

Placenta previa accreta may require hysterectomy because of the potential of massive obstetric hemorrhage. Overall, up to 92% of women require blood transfusion when traditional surgical management is used. 1 Hysterectomy may not be sought as a viable option for women requesting to preserve future fertility. Conservative management by leaving the placenta in utero and administration of methotrexate has been described in the literature. With the use of conservative management, the overall transfusion rate may be lowered substantially but still may be as high as 80%. 1 The problem faced at the conclusion of such management is when to proceed with removal of the placenta. This case report illustrates a new and objective way to determine when it is safest to surgically remove the placental tissue without the risk of excess bleeding in hopes of preserving reproductive function. The means to achieve this goal was the use of 3-dimensional (3D) power Doppler angiography to follow the receding blood vessels to the placenta by quantifying its amount of vascularization.