Placenta Accreta Spectrum – A Case Highlighting the Need for Early Diagnosis and Multidisciplinary Management

Placenta accreta spectrum (PAS) refers to abnormal invasion of the placenta into or through the uterine wall, ranging from accreta to increta and percreta, and is a major cause of maternal hemorrhage and peripartum hysterectomy. This case underscores the urgency of early recognition and coordinated care in high-risk pregnancies.

Case Summary

• Patient: 31-year-old, G4P1, with a previous cesarean section, presenting at 26 weeks of gestation with abdominal pain and intrauterine fetal demise.
• Initial management: Imaging via ultrasound and MRI detected retained placenta and abnormal placental implantation.
• Intraoperative findings: Manual extraction failed due to placenta accreta; emergency subtotal hysterectomy was performed under general anesthesia. Notably, dense omental adhesions, a displaced bladder, distorted uterine anatomy suggestive of a unicornuate uterus, and significant blood loss necessitating transfusion were encountered.
• Histopathology: Confirmed placenta accreta with chorioangiomatosis.

Key Insights

1. Early Identification is Crucial
• Risk factors such as prior cesarean delivery and uterine anomalies warrant thorough antenatal evaluation, including targeted ultrasound and, where available, MRI to assess placental depth and uterine invasion.
2. Peripartum Hysterectomy as Definitive Management
• In cases where placental separation is unsafe or impossible, timely hysterectomy—preferably subtotal to minimize operative time and blood loss—is life-saving.
3. Multidisciplinary Preparedness Saves Lives
• Successful outcomes depend on coordinated teams: obstetrics, anesthesia, blood bank, interventional radiology (where available), and critical care. Preemptive planning for massive hemorrhage and transfusion requirements is mandatory.
4. Complex Anatomy Requires Surgical Adaptability
• Unexpected uterine malformations or adhesions may complicate standard surgical approaches, emphasizing the importance of intraoperative flexibility and expertise.
5. Postoperative Monitoring and Future Counseling
• Intensive postoperative observation for hemorrhage, infection, and hemodynamic stability is essential. Patients should receive preconception counseling regarding the high recurrence risk of PAS in future pregnancies and the potential need for early referral to specialists.

Source: Dahiwale, S., Somalwar, S., &Bhalerao, A. (2025). Placenta accreta spectrum leading to peripartum hysterectomy: a case report. Cureus. https://doi.org/10.7759/cureus.83253