Placenta Accreta in an Upper Segmental Placenta: Not A Rare Case any More

Abstract

Placenta accreta spectrum (PAS) disorders are not limited to the lower segment placenta in the previously scarred uterus. A 30-year-old third gravida, with two previous spontaneous abortions, was admitted at 38 weeks and four days period of gestation for breech presentation presented to emergency in labour. She was in early labour, having mild contractions with a regular foetal heart. A decision to perform an emergency caesarean section was taken. An incision was made in the lower uterine segment, and a healthy female child of 2.8 kg was delivered. The placenta, however, could not be removed with gentle traction, and no plane of cleavage could be identified between the uterus and the placenta. The uterus was exteriorised, and the placenta was found to be firmly adhered to the uterine wall at the left fundal aspect, with thinning of overlying myometrium and prominent overlying blood vessels. An intraoperative diagnosis of the morbidly adherent placenta was made. A decision to perform an emergency obstetric hysterectomy was taken. The uterine incision was closed with placenta in situ and a total hysterectomy was performed. Hence, ultrasounds done during the antenatal period must screen for PAS even in the upper segment placenta of every patient with utmost caution to prevent surprises during delivery and optimise perinatal outcomes.