Placenta Percreta With Bladder Invasion: A Case Report Highlighting the Role of the Posterior Approach.

Placenta accreta spectrum (PAS) represents a recently recognised continuum of abnormal placental invasion, including placenta accreta, increta and percreta, which is a rare, life-threatening complication of pregnancy affecting both mother and foetus, characterised by placental invasion beyond the serosa, often involving adjacent structures such as the urinary bladder. The increasing incidence is associated with rising caesarean section rates and other related factors such as advanced maternal age and infertility treatments. Surgical management remains challenging due to the risk of extensive bleeding, urological injuries and increased maternal morbidity. The posterior approach has emerged as a potential lifesaving technique in these complex cases. We present a series of three cases diagnosed with placenta percreta and bladder invasion, managed at a tertiary care centre. Preoperative imaging (ultrasound and magnetic resonance imaging {MRI}) confirmed abnormal placental adherence. All cases involved multidisciplinary approaches, including urologists, obstetricians and interventional radiologists. A posterior approach was employed to minimise blood loss, reduce bladder injury and improve surgical control. The first case describes a 26-year-old woman who underwent a posterior approach hysterectomy, which successfully reduced blood loss to 600 mL while preserving the bladder. The second case was a 30-year-old woman with grade 4 placenta previa and suspected percreta who underwent preoperative uterine artery embolisation (UAE), followed by a posterior approach hysterectomy and partial cystectomy. The third case involved a 35-year-old woman who developed a right ureteral injury requiring ureteric reimplantation with contralateral double-J stenting. The posterior approach offers better vascular control, reduces bladder/ureteric injury and minimises blood loss. Early diagnosis, multidisciplinary planning and blood conservation strategies, such as uterine artery embolisation (UAE), are critical in improving outcomes. Future studies should further assess the long-term benefits of this approach in PAS management.