Pregnancy with an increased obstetrical risk. Placenta accreta. Trends

The chosen case is a particular one through the complexity of the pathology associated to the pregnancy, each of them in a direct way or in terms of the complications can give a major, vital risk maternal and fetal in any moment of the pregnancy, at birth or after birth.
I reported the case of a patient with an age of 46 years, caucasian race, from the country, who smokes a lot, pregnant with a twin pregnancy, 26 weeks, obtained through FIV with donor of ovocytes, who is hospitalized in emergency on 1.01.2016 in the Obstretical – Gynaecologic clinic of the Emergency clinical hospital “Saint Pantelimon”, Bucharest for high blood pressure and supervising the pregnancy of a highly obstretical risk.
After the anamnesis, the clinical exam and of the paraclinical research it is obtained a positive diagnosis and we define this pregnancy as being of a highly obstretical risk through: a pregnancy with twins, pregnancy obtained through FIV, HTA induced by pregnancy, cicatriceal uterus after the caesarian operation 2000, placenta praevia half central, acret, thrombophlebitis in treatment, advanced maternal age. Taking into consideration the pathologies associated to pregnancy, it is considered the necessity of a multidisciplinary supervising, of the pregnancy, in conditions of hospitalization.
At 33 weeks of pregnancy the condition of the patient and of the foetus regress clinically and paraclinically, showing the syndrome HELLP and preeclamsia, intrauterine growth restriction of both of the foetus, the cerebra-placental index reversing. After an adequate previous preparation, it is decided the delivery through cesareau operation; two alive fetuses are extracted with a good cardio-respiratory accomodation, intraoperatorily there are discovered multiple vessels of neoformation at vessels of neoformation at the level of the urinary bladder, one suspects the diagnosis of placenta increta in the urinary bladder, one continues the surgical intervention with a total, interaxial hysterectomy together with placenta, in an hemostatic purpose, without tempting previously the moving of the placentae.
Although associated to these multiple pathologies in the pregnancy, the birth could be accomplished at cold, with an adequate preoperatorily preparation avoiding in such a way the potential suplimentary complications of a surgical intervention in emergency.
Cesarean delivery and peripartum hysterectomy have been described as one of the riskiest and most dramatic operations in modern obstetrics [1].
The best management in case of placenta accreta is to not attempt to remove any of the placenta, either in an attempt to conserve the uterus or prior to hysterectomy, is associated with reduced levels of haemorrhage and a reduced need for blood transfusion.