Placenta increta presenting with threatened miscarriage during the first trimester in rhesus-negative mother: a case report

Nik Lah Nik-Ahmad-Zuky,Azmel Seoparjoo,Engku Ismail Engku Husna

doi:10.1186/s13256-021-03030-x

Nik Lah Nik-Ahmad-Zuky, Azmel Seoparjoo + Show 1 more

Open Access

https://doi.org/10.1186/s13256-021-03030-x

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Abstract

BackgroundPlacenta accreta is known to be associated with significant maternal morbidity and mortality—primarily due to intractable bleeding during abortion or delivery at any level of gestation. The complications could be reduced if placenta accreta is suspected in a patient with a history of previous cesarean delivery and the gestational sac/placenta is located at the lower part of the uterus. Then, a proper management plan can be instituted, and complications can be reduced. The diagnosis of placenta accreta in the first trimester of pregnancy is considered uncommon.Case presentationA 34-year-old Malay, gravida 4, para 3, rhesus-negative woman was referred from a private hospital at 13 weeks owing to accreta suspicion for further management. She has a history of three previous lower-segment cesarean sections. She also had per vaginal bleeding in the early first trimester, which is considered to indicate threatened miscarriage. Transabdominal ultrasound revealed features consistent with placenta accreta spectrum. She was counseled for open laparotomy and hysterectomy because of potential major complication if she continued with the pregnancy. Histopathological examination revealed placenta increta.ConclusionA high index of suspicion of placenta previa accreta must be in practice in a patient with a history of previous cesarean deliveries and low-lying placenta upon ultrasound examination during early gestation.

Highlights

Placenta accreta refers to abnormal trophoblast invasion involving part or all of the placenta into the myometrium due to a defect in the deciduo–myometrial interface, leading to morbid adherence to the uterus and an inseparable placenta upon delivery [1]
A high index of suspicion of placenta previa accreta must be in practice in a patient with a history of previous cesarean deliveries and low-lying placenta upon ultrasound examination during early gestation
The classical signs or clinical diagnosis of placenta accreta such as demonstration of placental lacunae, loss of the clear zone, bladder wall interruption, and uterovesical hypervascularity can be identified via ultrasound starting at 11–14 weeks of pregnancy [8]

Summary

Introduction

Placenta accreta refers to abnormal trophoblast invasion involving part or all of the placenta into the myometrium due to a defect in the deciduo–myometrial interface, leading to morbid adherence to the uterus and an inseparable placenta upon delivery [1]. We describe a case of a patient 13 weeks pregnant who had three previous cesarean deliveries, was Rh-negative, and diagnosed with placenta increta. Case presentation A 34-year-old Malay, gravida 4, para 3, Rh-negative woman was referred from a private hospital at 13 weeks owing to accreta suspicion for further management. She had a history of three previous lower segment cesarean sections, and all operations were uneventful. At 12 weeks of gestation, a repeat ultrasound showed that a viable fetus was located at the lower part of the uterus, and the placenta was covering the internal os, which was accompanied by loss of the hypoechoic border between the placenta and uterus; a diagnosis of placenta accreta was made. She was seen again after 1 month: she had no complaints, the wound was healed, and she was discharged from the gynecological clinic

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