Placenta Accreta Spectrum(PAS) with Ureteral Invasion due to Progression of Cesarean Scar Pregnancy(CSP)

A report describes a case of a 41-year-old woman with a history of three cesarean sections and two miscarriages who presented at 25 weeks of gestation and was admitted due to suspected placenta praevia. 26th-week cystoscopy showed vascular protuberances in the mucosa from near the bladder triangle to the posterior wall. 30th-week ultrasonography showed a bulging placenta within the scar, a posteriorly deviated cervical canal, and enlarged vessels protruding toward the bladder. These findings directed a diagnosis of PAS invading the bladder due to the continuation of CSP. MRI showed a vertically stretched bladder and placental protrusion towards the bladder, suggesting placental invasion into the bladder wall.

 Since the patient was considered at high risk for uterine rupture because of the increased vascular protrusion into the bladder and persistent uterine contractions in the preceding weeks, she underwent an elective cesarean hysterectomy at 31 weeks and six days of gestation. The baby was delivered through a transverse incision after a ureteral stent placement. Bilateral uterine and bladder arteries were also embolized. 

The bladder was dissected by tying off the cervix and leaving the placenta slightly on the bladder. The placenta adhered to the ureter and replaced the parenchyma. The uterus was then removed, and an aortic balloon was placed but was not inflated. 

The ureteral stent was extracted on postoperative day 22, although resection was done because of stenosis in the right ureter. On postoperative day 64, the stenosis improved, and the right ureteral stent was removed.

Yara N, Kinjyo Y, Chinen Y, et al. Placenta Accreta Spectrum with Ureteral Invasion due to Progression of Cesarean Scar Pregnancy. Case Reports in Obstetrics and Gynecology. 2023;2023. https://doi.org/10.1155/2023/9065978