A woman with previous two lower segment cesarean sections is found to have an anterior placenta previa at 28 weeks. MRI shows placental invasion into the bladder. What is the MOST appropriate intrapartum management strategy?

• A Lower segment cesarean at 34 weeks, leave placenta in situ, administer methotrexate postoperatively
• B Vaginal delivery at term after external cephalic version to allow spontaneous placental separation
• C Classical cesarean section at 36 weeks with immediate hysterectomy (cesarean hysterectomy) by multidisciplinary team ✓
• D Interventional radiology embolization at 32 weeks followed by expectant management until spontaneous labor

Explanation

Placenta percreta with bladder involvement is best managed by cesarean hysterectomy (with urology present for potential bladder repair) performed at 34–36 weeks as an elective planned procedure with multidisciplinary input (urology, interventional radiology, anesthesia, transfusion medicine). Leaving placenta in situ with methotrexate has high complication rates and is not standard. Vaginal delivery is contraindicated with previa and invasion. Embolization alone does not address the need for definitive surgical management.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.