Delayed Postpartum Hemorrhage: A Case of Placenta Accreta With No Known Risk Factors

Abstract

35-year-old woman, with one previous miscarriage managed conservatively, had a spontaneous vaginal delivery at 35 weeks’ gestation. She required dilatation and curettage for postpartum hemorrhage. During curettage, placenta accreta was suspected. The patient chose to undergo expectant management with oral antibiotic therapy and close follow-up. Further hemorrhage occurred on postpartum day 24. Ultrasound examination showed a 7.3 × 6.4 × 7.6 cm intrauterine mass consistent with placenta increta. Despite unilateral uterine artery embolization, the patient required repeated blood transfusions and eventually underwent hysterectomy on postpartum day 30. Final pathology showed placenta accreta (Figure 1), with a large amount of retained placenta (Figure 2). Expectant management of placenta accreta is reported to be successful in 78% of cases. 1 Uterine artery embolization can be helpful for bleeding associated with placenta accreta, but there is insufficient evidence to suggest that elective