Successful Conservative Management of Recurrent Focal Placenta Accreta, A Case Study

Abstract

Placenta accreta refers to an abnormality of placental implantation in which the anchoring placental villi attach to myometrium rather than decidua, resulting in a morbidly adherent placenta . It is a life-threatening diagnosis increasing in number due to the growing number of caesarean sections. For most patients, the method of choice is elective cesarean section followed by hysterectomy. For women who wish to preserve fertility, a conservative procedure may be considered. Almost all reported cases have known major risk factors which are previous caesarean section , current placenta previa , previous uterine surgery and known uterine anomalies .We report here an extremely rare case of recurrent focal placental accreta in 35 years old Saudi female, G3P2+0. 39 weeks pregnant, previous 1 cesarean section, breech with current focal accreta discovered late at 38wk +.Our case doesn’t have known major or even controversial minor risk factors in her 1st accreta.Risk factors for the second accreta were previous focal accreta at fundus and previous 1. In addition this is a successful uterine conservation for the 2nd time with no complications apart from mild bleeding of 2 liters- (the average usual bleeding is 6100 ). known complications for placental accreta include:Severe vaginal bleeding: 53 %, Sepsis: 6%, Secondary hysterectomy: 19% , death: 0.3 % 1 .Cesarean-hysterectomy is the best management of placenta accreta because it has reduced mortality and morbidity as well as injuries to nearby organs and hospital stay. It is important to report this case in order to keep in mind screening for suspicious of placenta accreta during perinatal US even if the patient has no risk factors in order to have planned delivery which will improve the mother and fetal outcome including most importantly decreasing the mortality rate due to postpartum hemorrhage and will increase the likelihood of successful uterine conservation especially in low parity patient.