Successful surgery on a difficult case: Central placenta previa with accreta for a patient with a history of two previous cesarean sections.
Central placenta previa combined with placenta accreta is the most severe clinical form of placenta previa, threatening the lives of both the mother and the fetus, often seen in mothers with a history of previous cesarean sections, making surgery difficult and causing significant blood loss. Recently, Hai Phong International Obstetrics and Pediatrics Hospital successfully performed surgery for a case of a mother suffering from both conditions, ensuring safety and a “healthy mother and baby” outcome for both the mother and the fetus.
The patient, T. T.B.N, 32 years old, residing in Thai Hoa commune, Nghe An province, has a history of two cesarean deliveries. However, her third pregnancy was not as smooth as the previous two. At 26 weeks of pregnancy, patient N visited a major medical facility in Hai Phong and was diagnosed with central placenta previa with placenta accreta, but this facility did not accept her for treatment. The patient researched and decided to choose Hai Phong International Obstetrics and Pediatrics Hospital for strict regular prenatal management. Throughout the pregnancy management process, the patient underwent various tests and closely monitored the development of the fetus. By the 37th week, Assoc. Prof. Dr. Trần Thị Việt Phương – Director of the Obstetrics Specialty Block, conducted a consultation and recommended surgery for patient N. This is a dangerous condition and one of the most challenging surgeries.in Obstetrics.
After the patient was thoroughly prepared, including blood and blood product provisions, the surgery was performed under the direct supervision of Assoc. Prof. Dr. Tran Thi Viet Phuong, Director of the Obstetrics Department, Dr. Pham Van Do – Deputy Head of the Delivery Department, Dr. Nguyen Thanh Quang, and the anesthesia team led by Dr. Nguyen Do Hung – Head of the Anesthesia and Resuscitation Department, along with the neonatal resuscitation team led by Dr. Trinh Thi Thuan – Head of the Pediatric Intensive Care Unit, who participated in supporting to ensure the safest delivery process for both the mother and the baby. The surgery took place on the morning of January 15, 2025. During the abdominal surgery, the team observed proliferating blood vessels forming a vascular network; the surgeons sought the area with the least blood vessels (the body of the uterus) to navigate through the placenta upwards to minimize bleeding, successfully delivering a baby boy weighing 3000 grams who cried out at birth, bringing joy and emotion to the entire team. After the delivery, there was a massive hemorrhage at the uterine incision site due to the mother’s history of two previous cesarean sections, and the bladder was adhered covering the entire lower part of the uterus, making the process of pushing the bladder down to proceed with the hysterectomy without damaging the bladder very challenging. However, thanks to their extensive experience and skill, the surgical team was able to…Quickly controlling the bleeding to proceed with a smooth hysterectomy without damaging the bladder. Controlling the bleeding from the bladder in the area where the placenta has penetrated is also a skilled art in surgery. After 1 hour and 13 minutes of surgery, the operation was completed, exceeding expectations. The patient received 5 units of red blood cells (1750 ml) and 2 units of fresh frozen plasma (700 ml), so after the surgery, the patient’s hemodynamics were completely stable. After 24 hours, the patient was transferred to the Postpartum Department, with the attentive care of Dr. Phạm Thị Thu Thủy – Head of the Postpartum Department, along with other doctors and nurses, the health of both mother and baby improved day by day, and they were discharged after 10 days.
Through the case of patient N, experts also advise expectant mothers to pay attention and closely manage their pregnancy, as many conditions have rather subtle signs, or even no symptoms at all. Therefore, managing pregnancy at reputable medical facilities is essential to ensure mothers have a healthy pregnancy, and if any conditions arise during pregnancy, they can be detected early and treated promptly.
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