Unexpected placenta accreta spectrum in a primigravida with an unscarred uterus: life-threatening hemorrhage following vaginal delivery
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20260567Keywords:
Hysterectomy, Placenta accreta, Placenta increta, Postpartum hemorrhage, Retained placentaAbstract
Placenta accreta spectrum disorders (PASD) are severe obstetric conditions associated with significant maternal and fetal morbidity. While the incidence of PASD has risen in correlation with increasing cesarean section rates, its occurrence in an unscarred uterus is exceptionally rare. We report a case of placenta increta in a 20-year-old primigravida with no identifiable risk factors. The diagnosis was made following a term vaginal delivery that was complicated by a retained placenta and subsequent life-threatening postpartum hemorrhage. This case is distinctive for its occurrence in a primigravida, contrasting with the few reported cases in unscarred uteri that are often described in multiparous women with a prior vaginal delivery. It underscores that PASD, while unlikely, can present in low-risk populations with no obstetric history. This report highlights the critical importance of maintaining a high index of suspicion and considering routine prenatal screening for radiological signs of PASD, even in low-risk populations.
References
Vuong A, Nguyen X, Nguyen P. Placenta accreta spectrum on an unscarred uterus in the third-trimester pregnancy: two rare cases at Tu Du Hospital in Vietnam. Int J Surg Case Rep. 2022;99:107603. DOI: https://doi.org/10.1016/j.ijscr.2022.107603
Mlay G, Augustino O, Kiritta R, Kaizilege G, Kihunrwa A, Bernard K, et al. Placenta Accreta Spectrum in Unscarred Uterus: A Case Report in a Tertiary Facility. EAS J Med Surg. 2023;5(10):239-42. DOI: https://doi.org/10.36349/easjms.2023.v05i10.010
Elkarkri C, Ammouri S, Anas A, Lakhdar A, Zeraidi N, Baidada A. Placenta accreta in an unscarred uterus: a case report. PAMJ Clin Med. 2020;3(69). DOI: https://doi.org/10.11604/pamj-cm.2020.3.182.22628
El Gelany S, Mosbeh MH, Ibrahim EM, Mohammed M, Khalifa EM, Abdelhakium AK, et al. Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study. BMC Pregnancy Childbirth. 2019;19(1):313. DOI: https://doi.org/10.1186/s12884-019-2466-5
Perlman N, Carusi D. Retained placenta after vaginal delivery: risk factors and management. Int J Womens Health. 2019;11:527-34. DOI: https://doi.org/10.2147/IJWH.S218933
Fratelli N, Fichera A, Prefumo F. An update of diagnostic efficacy of ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders. Curr Opin Obstet Gynecol. 2022;34(5):287-91. DOI: https://doi.org/10.1097/GCO.0000000000000811
Kumari, O, Gaurav A, Khoiwal K, Gupta A, Kapur D, Halder R, et al. Incidentally diagnosed placenta accreta managed conservatively in a primigravida: case report and review of literature. Int J Reprod Contracept Obstet Gynecol. 2022;11(5):1588-91. DOI: https://doi.org/10.18203/2320-1770.ijrcog20221301
Garg P, Semwal S, Bansal R. Unexpected placenta accreta spectrum in an unscarred uterus causing catastrophic post-partum hemorrhage: a case report and review of the literature. BMC Pregnancy Childbirth. 2025;25(1):14-9. DOI: https://doi.org/10.1186/s12884-025-07140-y
Downloads
Published
How to Cite
Issue
Section
