A 34-year-old woman with two previous cesarean sections undergoes elective repeat cesarean at 37+6 weeks. Intraoperatively the placenta is found to be deeply invading the myometrium with no visible cleavage plane. The most appropriate management is:

• A Manual removal of placenta followed by B-Lynch suture
• B Leaving the placenta in situ and closing the uterus (conservative management)
• C Peripartum hysterectomy without attempting placental removal ✓
• D Internal iliac artery ligation followed by manual removal

Explanation

Placenta percreta (or increta without cleavage plane) identified intraoperatively is best managed by peripartum hysterectomy without attempting manual removal, as attempts at manual removal cause life-threatening haemorrhage. Conservative management (leaving placenta in situ) may be an option in carefully selected cases desiring fertility, but hysterectomy is the definitive and most widely recommended approach. B-Lynch suture addresses atony, not morbid adherence.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.