A case of placenta increta in placenta previa: a rare case report

Badal Das, Debobroto Roy, Malay Sarkar, Krishna Pada Das, Nazmin Khatun, Aritrick Moulick


Placenta increta, one type of morbidly adherent placenta, is characterized by entire or partial absence of the decidua basalis, and by the incomplete development of the fibrinoid or Nitabuch’s layer and villi actually invading the myometrium. When the internal os is covered partially or completely by placenta, it is described as a placenta previa. Simultaneously these two complications occurring in a post LSCS scarred uterus is a very rare scenario and anticipated frequently to cause catastrophic obstetric outcome. A 32-years-old woman of second gravida, para 1, with previous history of LSCS 7 years back, with living issue one, admitted in our hospital at 35 weeks 5 days gestation with asymptomatic placenta previa with placenta increta. The case was diagnosed effectively by ultrasonography. Intra-operatively, compression sutures and bilateral uterine artery ligature was tried to control hemorrhage which were failed and a quick decision of caesarean hysterectomy was done. Preserving both ovaries, total hysterectomy was the only option to save the mother in our case. Other options attempting to preserve uterus could have ended up with grave consequences in this case. This was a very rare case of asymptomatic placenta previa with placenta increta in a post LSCS scarred uterus and it was successfully managed by judicious caesarean hysterectomy.


Caesarean hysterectomy, Decidua basalis, Morbidly-adherent placenta, Myometrium, Nitabuch’s layer

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Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffmann BL, Casey BM, et al. Williams Obstetrics. 25th ed. New York, NY: McGraw Hill; 2018: 773-782.

Kumari S, Singh B. Maternal and perinatal outcome of placenta previa in a tertiary care centre: an observational study. Int J Reprod Contracept Obstet Gynecol. 2018;7:4701-5.

Berchuck A, Sokol RJ. Previous cesarean section, placenta increta, and uterine rupture in second-trimester abortion. Am J Obstet Gynecol. 1983;145:766-7.

Mehrabadi A, Hutcheon JA, Liu S, Bartholomew S, Kramer MS, Liston RM, et al. Contribution of placenta accreta to the incidence of postpartum hemorrhage and severe postpartum hemorrhage. Obstet Gynecol. 2015;125(4):814-21.

Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol. 2011;205(3):262.

Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997;177:210-4.

Haynes DI, Smith JH, Fothergill DJ. A case of placenta increta presenting in the first trimester. J Obstet Gynaecol. 2000;20:434-5.

Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y. Placenta accreta--summary of 10 years: a survey of 310 cases. Placenta. 2002;23(2-3):210-4.

Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med. 1992;11:333-43.

Lam G, Kuller J, Mahon M. Use of magnetic resonance imaging and ultrasound in the antenatal diagnosis of placenta accreta. J Soc Gynecol Investig. 2002;9(1):37-40.

Fox H. Placenta accreta, 1945-1969. Obstet Gynecol Surv. 1972;27:475.

Liu X, Fan G, Jin Z, Yang N, Jiang Y, Gai M, et al. Lower uterine segment pregnancy with placenta increta complicating first trimester induced abortion: diagnosis and conservative management. Chin Med J. 2003;116(5):695-8.

Suner S, Jagminas L, Peipert JF, Linakis J. Fatal spontaneous rupture of a gravid uterus: case report and literature review of uterine rupture. J Emerg Med. 1996;14(2):181-5.

Crespo R, Lapresta M, Madani B. Conservative treatment of placenta increta with methotrexate. Int J Gynecol Obstet. 2005;91:162-3.

Kayem G, Davy C, Goffinet F, Thomas C, Clement D, Cabrol D. Conservative versus extirpative management in cases of placenta accreta. Obstet Gynecol. 2004;104(3):531-6.

Liao CHY, Ding DCH. Failure of conservative treatment for placenta increta. Taiwan J Obstet Gynecol. 2009;48:302-4.