Prophylactic trans-uterine embolization to reduce intraoperative blood loss for placenta percreta invading the urinary bladder

Reported herein is the case of a 35-year-old multipara woman diagnosed (on sonography) with total placenta
previa that had ruptured through the myometrium of the uterus, invading the wall of the urinary bladder. In
the 32nd week of gestation the patient underwent an emergency cesarean section due to profuse vaginal
bleeding. Due to possible intraoperative massive bleeding during removal of the placenta it was decided to
preserve the uterus and placenta temporarily. The patient underwent superselective trans-uterine embolization
through the bilateral anterior branches of the hypogastric arteries, using gelfoam cubes and coils. Two days
later cesarean hysterectomy was performed, and the placenta was successfully removed from the invaded
urinary bladder. The whole procedure went smoothly and the estimated blood loss was only 1300 mL.
Key words: chorionic villi, placenta percreta, total placenta previa, trans-uterine embolization, uterine arteries.