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Case Report
First trimester diagnosis of placenta accreta spectrum resulting in spontaneous uterine rupture: A case report
1 Department of Obstetrics and Gynecology, University of California, San Francisco-Fresno, USA
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Subhashini Ladella
MD, FACOG, Department of Obstetrics and Gynecology, University of California, San Francisco-Fresno,
USA
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Article ID: 100078Z08SL2021
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Ladella S, Ng S. First trimester diagnosis of placenta accreta spectrum resulting in spontaneous uterine rupture: A case report. J Case Rep Images Obstet Gynecol 2021;7:100078Z08SL2021.ABSTRACT
Introduction: Placenta accreta spectrum (PAS) is a severe form of abnormal placentation associated with significant maternal morbidity and mortality due to life-threatening hemorrhage. First trimester detection of abnormal placental implantation, especially placenta percreta, is a rare phenomenon and can be a diagnostic challenge by prenatal ultrasonography. The incidence of PAS has increased in the past four decades due to higher rates of cesarean deliveries, uterine surgeries, endometrial curettages, and other maternal co-morbidities. We report a case of PAS detected in first trimester and explored the sensitivity of first trimester ultrasound diagnosis of PAS.
Case Report: We describe a case of a 33-year-old woman who presented with first trimester vaginal bleeding and was diagnosed with placenta accreta spectrum by ultrasonography in the first trimester. She was followed closely with serial ultrasound scans and diagnosed with intrauterine fetal demise at 15 weeks gestation. Intraoperative findings confirmed spontaneous uterine rupture with placenta invading into the bladder wall. She underwent a total abdominal hysterectomy and bilateral salpingectomy. The histopathological findings were consistent with placenta percreta.
Conclusion: Review of literature, addressing early diagnosis of abnormal placental implantation and adhesion, confirmed that the sensitivity and specificity of first trimester ultrasound diagnosis of PAS was lower than second trimester diagnosis. Our case report highlights the importance of further development of ultrasound training, education, and awareness of early detection of PAS to effectively manage and reduce adverse pregnancy outcomes.
Keywords: First trimester diagnosis, Placenta accreta spectrum, Uterine rupture
SUPPORTING INFORMATION
Author Contributions
Subhashini Ladella - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Stephanie Ng - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Subhashini Ladella et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
