Detection of Placenta Percreta with Urinary Bladder Wall Invasion by Two-Stage Imaging Protocol - A Case Report

Invasive placenta is a placental adhesive disorder characterized by a defect of decidua in which chorionic villi (fetal trophoblast) extend into the myometrium. Based on the extent of myometrial invasion, invasive placenta is of three types -placenta accreta, placenta increta and placenta percreta. The incidence of invasive placenta increases with placenta previa and previous history of caesarean section. A two-stage imaging protocol for detection of invasive placenta is suggested which includes an initial evaluation with ultrasound and color Doppler (which usually detects invasive placenta) followed by pelvic MRI for placenta which confirms the diagnosis of invasive placenta with extra-uterine extension. We report a case of placenta percreta invading urinary bladder wall detected initially by ultrasound, color and power Doppler and later confirmed on MRI. These findings were confirmed during emergency caesarean section.