Placenta Increta at Unscarred Area in a Previous Caesarean Women: A Case Report of an Unusual Pathogenesis of Usual Etiology

Abstract

Morbidly adherent placenta usually presents with heavy bleeding and difficulty in placental removal in the third stage. Although association of morbidly adherent placenta with previous caesarean section or uterine surgery is well documented the exact pathogenesis of placenta accrete still remains unknown. We hereby report a case of spontaneous second trimester abortion followed by recurrent intermittent hemorrhage leading to hypovolemic shock. Following this hysterectomy was done, which on histopathology revealed placenta increta away from previous uterine scar site. Pathogenesis in this case for morbidly adherent placentation seems to be resembling that in a woman without any previous uterine surgery or scar, which is quite unusual. We report this case with a brief review of the literature.

Conventional and conservative management of placenta accreta is two ends of a single continuum: A report of three cases and literature review

“…Most commonly, it is a consequence of a partial or complete absence of the compact and spongy layer known as the decidua basalis, and misdevelopment of the fibrinoid Nitabuch's layer which lies between the boundary zone of the thick endometrium and the cytotrophoblastic shell in the placenta . The placental villi attached and are only slightly embedded into the myometrium in Placenta accreta (more than 70% cases), deeply invade into the myometrium in placenta increta (13%) and invade the perimetrium even infiltrating adjacent structures of the pelvic floor in placenta percreta (5%) …”

“…2 The placental villi attached and are only slightly embedded into the myometrium in Placenta accreta (more than 70% cases), deeply invade into the myometrium in placenta increta (13%) and invade the perimetrium even infiltrating adjacent structures of the pelvic floor in placenta percreta (5%). 3 Clinically, severe complications of PA include severe obstetric hemorrhage leading to disseminated intravascular coagulopathy (DIC), iatrogenic injury to the ureters, bladder, bowel, respiratory distress syndrome (RDS), acute transfusion reactions, electrolyte imbalance, and renal failure. In women with PA, the expected blood loss at delivery is 3000-5000 mL, and maternal deaths rate is as high as 7%.…”