Emergency Hysterectomy after Second Trimester Abortion in a Patient with Placenta Accreta Spectrum Disorder, Who had Four Cesarean Deliveries

Emergency Hysterectomy due to Second Trimester Abortion

Abstract

Objective: To present performing 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, who had prior four cesarean deliveries, presented with pelvic pain and excessive vaginal bleeding following fetal abortion. The patient’s hemodynamic status worsened. The patient underwent operation, and the bladder was densely adhered to the previous incision. Classic hysterectomy was performed up to the level of the uterine artery bilaterally. Then uterine arteries was skeletonized and ligated before the bladder dissection. The anterior visceral peritoneum was dissected at the isthmic level. The bladder, below the adhesion, was dissected in the lower uterine segment with lateral approach. The adhesion was dissected, and the bladder was removed from uterus and the hysterectomy was completed.

Conclusion: Obstetricians should be familiar with the diagnosis and management of PAS. The uterine artery could be ligated before the bladder dissection in emergency case. After caseation of bleeding the bladder could be dissected the lower uterine segment, and a safe hysterectomy is carried out.