Emergency hysterectomy after 2nd trimester abortion in a patient with placenta accreta spectrum disorder who had four cesarean deliveries

Abstract

Objective: To perform an emergency hysterectomy by ligation of the uterine arteries before bladder dissection in a patient with placenta accreta spectrum disorder who developed excessive hemorrhage after abortion. Case report: A patient with four previous cesarean deliveries presented with pelvic pain and excessive vaginal bleeding following a fetal abortion. The patient’s hemodynamic status worsened. The patient underwent surgery, and the bladder was densely adherent to the previous incision scar. A classic hysterectomy was performed up to the level of the uterine artery bilaterally. The uterine arteries were then skeletonized and ligated before bladder dissection. The anterior visceral peritoneum was dissected at the isthmic level. The bladder below the adhesion was dissected in the lower uterine segment using a lateral approach. The adhesions were dissected, the bladder was removed from the uterus, and a hysterectomy was performed. Conclusion: Obstetricians should be familiar with the diagnosis and management of placenta accreta spectrum disorders. In an emergency, the uterine artery could be ligated before bladder dissection. After cessation of bleeding, the bladder could be dissected from the lower uterine segment and a safe hysterectomy could be performed. Key words: abortion – hemorrhage – hysterectomy – placenta accreta spectrum