Objective: To report the treatment of a clinical case with central placenta previa accreta. During pregnancy image diagnosis (ultrasound and magnetic resonance imaging) revealed localization and penetration of the placenta into the uterine wall. Just before delivery to reduce the bloss loss and avoid maternal hypotension and facilitate surgery, intra arterial balloons were placed on both hypogastric arteries by the radiologist; intravascular monitoring was installed by anesthesist and urologist put in ureteral catheters. The delivery was by cesarean section and followed by histerectomy leaving the placenta in situ. The case correspond to a woman of 32 years old that had 2 previous cesarean section. During this pregnancy bled a few times and was delivered at weeks 36th. During surgery she was stable, requiring one unit of red blood cells and four liters of coloids and crystaloids. Post-operative course was with no problems. The pathologist report a placenta percreta with no bladder involvement, agreeing with the vascular lakes image and the cystoscopy. Conclusion: This case reveals the benefits of multidisciplinary approach to manage severe complications of pregnancy such as placenta previa and the degree of accretism.

Objetivo: Evaluar la eficacia y resultados del tratamiento de la placenta acreta previa central en un caso clínico. Durante el embarazo los métodos diagnósticos por imágenes (ultrasonido y resonancia nuclear magnética) precisaron la localización y penetración de la placenta en la pared uterina. En el período inmediato antes del parto, para disminuir la hemorragia, evitar la hipotensión materna y facilitar el procedimiento quirúrgico, se colocaron balones intraarteriales en ambas ilíacas internas por radiólogo intervencionista, catéteres para monitoreo hemodinámico invasivo por anestesiólogo y catéteres ureterales por urólogo. La resolución del parto fue por cesárea-histerectomía sin remoción de la placenta. El caso correspondió a una paciente de 32 años con cesárea en dos partos anteriores, metrorragia episódica y que fue interrumpida en la semana 36. Durante toda la intervención permaneció hemodinámicamente estable requiriendo 1 unidad de glóbulos rojos, 4 litros entre coloides y cristaloides y el posoperatorio fue sin incidentes. El examen histo-patológico demostró percretismo de la pared uterina sin invasión vesical, concordante con las imágenes de lagunas vasculares y la citoscopia. Conclusión: El caso demuestra el beneficio del tratamiento especializado multidisciplinario de embarazos con complicaciones graves como la placenta previa con diferentes grados de acretismo.

Background: Ultrasonography is useful in trauma patients to detect pleural effusions or peritoneal fluid. Aim: To assess the value of ultrasonography performed by surgeons in the assessment of trauma patients. Material and methods: A retrospective review of ultrasonography reports and clinical history of 284 trauma patients. Results: One hundred fifty six patients had blunt trauma and 128 had penetrating trauma. Ultrasonography detected peritoneal fluid in 20%, pericardial effusion in 1% and pleural effusion in 1%. Eight percent had visceral damage or hematomas, without peritoneal fluid. None of the patients with a normal ultrasonography required surgery for hemoperitoneum; however, four patients had intestinal perforations and required surgery. Conclusions: Ultrasonography had a 100% sensitivity and specificity for the detection of clinically significant hemoperitoneum. Emergency ultrasonography performed by surgeons is useful and accurate (Rev Méd Chile 2002; 130: 892-6)