Placenta percreta with bladder invasion: report of three cases.

Three cases are reported of placenta percreta with urinary bladder wall invasion. All three patients had complete placenta previa and each had five previous cesarean sections. Placental invasion caused a giant vesicouterine fistula in the first case. The second patient had a cesarean hysterectomy and the placental portion that penetrated the bladder wall was left to absorb spontaneously. The third patient underwent a cesarean supracervical hysterectomy during which the bladder invasion was left undisturbed. She received intraoperative methotrexate, and pelvic packing and bilateral hypogastric ligation were helpful in hemorrhage control.