A 34-year-old G4T3P0A0L2 was referred to the Division of Maternal Fetal Medicine (MFM) at 28+4 weeks’ gestation for antepartum bleeding with placenta previa and possibly percreta. The patient had 3 previous vaginal deliveries. The third was complicated by postterm induction of labor, shoulder dystocia, postpartum hemorrhage, and uterine rupture into the broad ligament requiring laparotomy and repair.
An ultrasound revealed placenta previa with placental-myometrial differentiation, but with bridging vessels and subplacental and uterovesical hypervascularity suspicious for placenta percreta ( Figure 1 ). A cesarean hysterectomy was planned for 34+2 weeks’ gestation following discussion with specialists from MFM, gynecology, urology, anesthesia, and allied health. A preoperative cystoscopy revealed bulging into the bladder but no mucosal invasion ( Figure 2 ). Intraoperatively, an anterior placenta previa and large bladder varicosities were encountered ( Figures 3 and 4 ). The patient had a classical cesarean delivery with the uterus conserved ( Figure 5 ).
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