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SUCCESSFUL DELAYED‐INTERVAL DELIVERY IN MONOCHORIONIC DIAMNIOTIC TWIN PREGNANCY

Balachandar K, Inglis E Westmead Hospital, Sydney, New South Wales, Australia Email: kapilesh.balachandar@health.nsw.gov.au Background: Placenta accreta is characterized by abnormal invasion of placental villi into the uterine wall. We present a case of placenta accreta complicating a dichorionic diamniotic twin pregnancy, requiring emergent delivery by caesarean hysterectomy. Case Presentation: Mrs SO was a 36-year-old lady, G3P2, who presented to Westmead Hospital’s labor ward at 30 weeks and 2 days gestation with fulminant HELLP syndrome, preeclampsia and evidence of foetal distress. Her presentation was in the context of a dichorionic diamniotic twin pregnancy complicated by a known accreta of twin 2’s placenta. The decision was taken for transfer to theatres for an emergency caesarean hysterectomy. Both twins were delivered by breech extraction before the placenta of twin 1 was removed by continuous cord traction. The uterus was closed routinely, leaving the placenta of twin 2 in situ and removed en bloc by hysterectomy. Mrs SO required admission to ICU post-operatively prior to discharge home 7 days after her presentation. Conclusions: Placenta accreta is an uncommon obstetric complication, especially in cases of multiple gestations while the association with pre-eclampsia is not remains uncertaine. Optimal management involves multidisciplinary planning in the antenatal setting, with input from interventional radiologists, gynaecological oncologists, anaesthetists and directed by a team of obstetricians. However, we highlight the point that in circumstances when this is not possible, ensuring the availability of senior staff at time of the caesarean hysterectomy is associated with significantly improved intraoperative and postoperative outcomes.