Esmer Ahmet Rıza, Aslancan Reyhan, Teymen Burak, Çalışkan Eray
Gebze Medical Park Hospital, Clinic of Obstetrics and Gynecology, İzmit, Turkey.
Bahçeşehir University Faculty of Medicine, İstanbul, Turkey.
Turk J Obstet Gynecol. 2018 Jun;15(2):130-132. doi: 10.4274/tjod.82642. Epub 2018 Jun 21.
Placenta previa percreta is a serious pregnancy condition that may cause massive bleeding. Life-threatening hemorrhage is commonly managed via cesarean hysterectomy or vascular ligations in order to preserve fertility. We present a case of bilateral external iliac artery thrombosis after pelvic compression and uterine devascularization due to placenta previa percreta. The patient had cesarean section due to ultrasonography and magnetic resonance imaging-diagnosed placenta previa percreta, and stated that she preferred a conservative approach rather than hysterectomy in a case of massive bleeding. Spontaneous hemorrhage was recognized during the operation. Pelvic compression and bilateral uterine and internal iliac artery ligations were performed. The left external iliac artery was accidentally held and bonded as the left internal iliac artery, which was turned loose within a minute after distinguishing the vessels. Emergency angiography that was applied because of patient's leg pain showed bilateral external iliac artery thrombosis. Angioplasty was performed by a cardiologist for bilateral occlusions. Placenta invasion abnormalities may be managed by pelvic compression or vascular ligations, which have their own serious complications that the surgeon must manage immediately.
穿透性胎盘前置是一种严重的妊娠情况，可能导致大量出血。为了保留生育能力，危及生命的出血通常通过剖宫产子宫切除术或血管结扎术来处理。我们报告一例因穿透性胎盘前置导致盆腔受压和子宫去血管化后双侧髂外动脉血栓形成的病例。该患者因超声和磁共振成像诊断为穿透性胎盘前置而行剖宫产，并表示在大出血情况下她倾向于保守治疗而非子宫切除术。术中发现自发性出血。进行了盆腔压迫以及双侧子宫和髂内动脉结扎。左髂外动脉被误当作左髂内动脉夹住并结扎，在区分血管后一分钟内松开。因患者腿痛而进行的急诊血管造影显示双侧髂外动脉血栓形成。心脏病专家对双侧闭塞进行了血管成形术。胎盘植入异常可通过盆腔压迫或血管结扎来处理，但这些方法有其自身严重的并发症，外科医生必须立即处理。
