Placenta Increta
A 26-year-old woman at 32 weeks of gestation presented to the emergency department with painful uterine contractions. This pregnancy was the patient’s third; she had a history of two cesarean deliveries. Cervical examination showed dilation to 3 cm with 40% effacement. Cesarean section was performed owing to the high risk of uterine rupture. During the procedure, multiple placental vessels were visualized on the lower outer uterine walls. The surgery was converted to a cesarean hysterectomy with the delivery of a healthy infant. The surgery was complicated by postpartum hemorrhage of 4000 ml, for which the patient underwent transfusion according to an institutional protocol for massive transfusion. No bladder injury occurred. Placenta increta was identified on histopathological examination. Disorders of abnormal placental adherence to the uterine myometrium, also known as placenta accreta spectrum, are associated with prior cesarean delivery and may remain undiagnosed until the time of delivery, as in this case. Identification is paramount to avoid major complications, such as postpartum hemorrhage. After observation in the intensive care unit, the patient was discharged home with her infant on postpartum day 5.