Placenta previa percreta involving the urinary bladder: a report of two cases and review of the literature.

The incidences of both placenta previa and placenta accreta are increased in patients with scarred uteri, and patients with uterine scars and placenta previa are at increased risk for also having placenta accreta. Two cases are presented of placenta previa percreta with involvement of the urinary bladder necessitating cesarean hysterectomy, partial cystectomy, and, in one case, bilateral ureteral reimplantation. Both patients had two previous cesarean deliveries. Serious hemorrhage is common in patients with placenta percreta. The primary goal of surgical management must be to control bleeding, which usually requires resection of all tissue involved by the infiltrating placenta. After hemorrhage is controlled, the surgeon must reestablish the integrity of the urinary system and reconstruct the pelvis as necessary.