Clinical profile and maternal outcomes in placenta accreta spectrum disorder: a case series from a tertiary care centre in north India

Abstract

Placenta accreta spectrum (PAS) disorder, encompassing placenta accreta, increta, and percreta, represents an increasingly prevalent and life-threatening obstetric complication, with its incidence rising sharply in parallel with escalating global caesarean section rates. We present a case series of four patients diagnosed with PAS who were managed at a tertiary care centre in North India between January and March 2026. All four patients had a history of at least two prior lower segment caesarean sections, and presented with varying degrees of placental invasion identified on ultrasonography and magnetic resonance imaging (MRI). The gestational ages at presentation ranged from 15.5 to 37 weeks, with clinical features including antepartum haemorrhage, anaemia, and haemodynamic instability in select cases. All four patients underwent obstetric hysterectomy; bilateral internal iliac artery ligation was performed in three cases to achieve haemostasis, and bladder injury necessitating intraoperative repair was encountered in three cases. Massive transfusion protocols were instituted across all cases. Three patients recovered satisfactorily and were discharged without long-term morbidity; one patient succumbed to refractory haemorrhage and disseminated intravascular coagulation in the postoperative period. This series underscores the critical importance of antenatal suspicion, early radiological diagnosis, timely referral to tertiary centres, and planned delivery by a dedicated multidisciplinary team. Strengthening surveillance in women with prior uterine surgery and ensuring institutional preparedness for complex pelvic surgery and massive transfusion are essential to improving maternal outcomes in PAS.