A first trimester scan may reveal the presence of placenta accreta. Absence of the anterior uterine wall during caesarean section: An unexpected placenta accreta that was treated conservatively

Abstract

Objective: Placenta accreta spectrum (PAS) is a rare condition, but it is a potential life threating obstetric event.
Case report: A second-time mother, 32◦years old, has had a caesarean section before. At 11◦weeks, a doubt about scar pregnancy was posed but not confirmed at subsequent serial ultrasound evaluations. A caesarean section was performed at 38.4◦weeks for breech presentation. A placenta accreta, diagnosed during surgery and confirmed by histological evaluations, was visible at uterine examination with a lacuna in the anterior uterine wall. After fetal extraction, the surgeons opted for conservative management. Subsequent clinical and ultrasound followup described a patient in a good state of health with a progressively reduced intrauterine placenta residual.
Conclusion: (1) Even in the absence of typical second- or third-trimester ultrasound signs, first trimester ultrasound played a role in posing the suspect of PAS. (2) Conservative management could be a safe option in cases of undiagnosed PAS, even if reported in the literature as a correlation with possible subsequent complications, which must be explained to the patient with adequate counseling