PMC6139238_01
Doppler ultrasound in the sagittal plane at midline in the pelvis demonstrates turbulent peripheral vascularity in the placenta extending across the myometrium to the posterior wall of the bladder. The bladder contour is otherwise smooth; however, the finding remains highly suggestive of placenta percreta. No defect in the uterine wall could be identified, but given the large volume of hemorrhagic ascites, an emergency diagnostic laparoscopy was subsequently performed.
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fig1
The placenta was again noted to be heterogeneous with multiple irregularly shaped lacunae, and the border between the myometrium and placenta was difficult to identify along the anterior wall, as shown in Figure 1.
Intact hysterectomy specimen. Anterior wall demonstrates softened tumescence, with patchy hemorrhagic and congested appearance.
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fig2
The serosal surface was intact, except for a 1.0 x 0.6 cm variegated, slightly ragged area, at the midline of the anterior wall, approximately equidistant from the fundus and cervix (Figure 2).