A 34-year-old woman undergoes cesarean section. During the procedure, the surgeon notes that the placenta is densely adherent to the uterine wall and cannot be separated. A decision is made to perform cesarean hysterectomy. While dissecting the bladder from the lower uterine segment, the surgeon encounters massive venous bleeding from the posterior bladder wall. This complication is MOST specifically associated with which type of placenta accreta spectrum?
- A Placenta percreta with bladder involvement ✓
- B Placenta increta
- C Placenta accreta
- D Placenta previa without invasion
Correct answer: A. Placenta percreta with bladder involvement
Explanation
Placenta percreta with bladder invasion is the type most associated with bladder injury and hemorrhage during cesarean hysterectomy. The placental villi penetrate through the myometrium and serosa into the bladder wall, making dissection of the bladder flap extremely hazardous. Preoperative ureteral stenting and involvement of urology or gynecologic oncology is often required. Accreta and increta do not involve the bladder.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.