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Uterine conservation in patient with consecutive double placenta percreta

A 28 year-old patient in the 35th week of her 6th pregnancy was admitted for placenta percreta with vesical invasion (enhanced MRI). As an antecedent the patient had previously had five cesarean sections and, during her latest section, she had had placenta percreta with vesical invasion. On this occasion conservative surgery of the uterus was performed with aortic vascular control, and uterine and vesical plastic operation. The patient underwent general anesthesia and immediately after she was anesthetized a median incision was made. Then, after fundal hysterotomy, a male newborn was extracted. The baby weighed 1190 grams, Apgar was 7/10. After hemostasis, the patient was placed in Trendelenburg’s position, the uterus was luxated forward and the retroperitoneum was accessed. The abdominal aorta was approached between lumbar vertebrae 3 and 4; a double aortic loop with silk number 7 was made below the infrarenal aorta and 3.500 U I.V. Sodium Heparin was administered. Then, dieresis of the vesico-uterine space was carried out by ligation of every newly formed vessel between the two organs. Once this stage was over, uterine, ovarian and the two posterior cervical arteries were sutured. Forty-five minutes later the aortic loop was loosened and 30 units of intravenous drip oxytocin were administered. Intrauterine hemostasis was checked as well as the indemnity of uterine and vesical surfaces. In particular, the previously repaired uterine surface appeared firm, with an approximate thickness of 1 cm and full of newly formed vessels. Hemostatic stitches were made with Dexon 3.0 in small bleeding retrovesical points. The abdomen was closed in a plane with Nylon 0 monofilament. Total transfused volume in the operating theater was 2 units of fresh frozen plasma, 2 units of whole blood and 2,000 ml of crystaloids.