Challenges in Diagnosis and Management in Placenta Accreta Spectrum: A Case Report

Abstract

Background: Placenta accreta describes aberrant placentation characterized by abnormally implanted, invasive or adhered placenta. Myometrial fibers attached to the basal plate in an antecedent pregnancy are predictive for a subsequent placenta accreta spectrum. Placenta accreta spectrum is a leading cause of haemorrhage and emergency peripartum hysterectomy. Risk Factors are placenta previa in present pregnancy, prior surgery like caesarean section, hysterotomy, myomectomy, metroplasty, curettage, endometrial ablation. There are many challenges in diagnosing placenta accreta spectrum because of limitations in imaging modality in emergency situations. Most of the times, placenta accreta spectrum is an intraoperative diagnosis leading to catastrophe.

Case: 25-Y/O G3P1L1A1 with 19-weeks of gestation with previous Lower Segment Cesarean Section (LSCS) with intrauterine fetal demise came to casualty with c/o profuse pv-bleeding for one hour. On examination her shock index was 1.3. USG S/O IUFD 18 weeks of gestation with grade 4 placenta previa suspicious placenta accreta. Emergency hysterotomy done for complete Placenta previa. Intraoperative finding of placenta accreta spectrum with patient’s shock index of 1.3, emergency obstetric hysterectomy was done. Uterus with placenta sent for histopathology examination. Pt was given 7 PCV, 4 FFP, 4 RDP. Histopathology report s/o placenta percreta. Patient was discharged on post operative day 10.

Conclusion: Maternal morbidity and mortality are significantly correlated with placenta accreta spectrum. Group 5 accounts for the highest percentage of caesarean sections (34.97%) in accordance with Robinson’s classification. Prenatal screening is crucial in light of this frequency.

In patients who have had one previous caesarean procedure, the frequency of placenta accreta spectrum rises to 25%, and in patients who have had two previous caesarean sections, it rises to 40%. Early diagnosis of placenta accreta spectrum can be aided by clinical evaluation of risk factors and the use of the proper imaging modalities. Reducing morbidity and mortality and enhancing maternal and foetal outcomes depend on antenatal diagnosis. The most qualified and experienced surgeons and interventional radiologists should handle placenta accreta spectrum conservatively in a facility with a multidisciplinary team, intensive care unit capabilities, and sufficient blood and blood products.