Evolving Cesarean Scar Pregnancy into Morbidity Adherent Placenta-Evidence from Serial Ultrasound Examination

To present the complete history of a case with placenta accreta and demonstrate the special clues of ultrasonography finding during whole trimesters from early pregnancy to delivery.

A multiparous 28-year-old female with a history of multiple cesarean deliveries was found with suspected precesarean section scar pregnancy at 6 weeks of gestation. We performed a series of ultrasonography scans, which revealed placenta previa totalis and placenta accreta at 15 and 32 weeks of gestation, respectively. A well-planned cesarean section with hysterectomy was performed at the 35^th week of gestation with massive blood transfusion support, and an alive female baby-with a birth body weight of 2485 g, and Apgar score of 9 at the 1^st minute and 10 at the 5^th minute-was born. The intraoperative blood loss was 7000 mL, and no postoperative hemorrhage or other complication occurred.

Ultrasonography remains the main tool for diagnosis of morbid adherent placenta with several typical clues, including abnormal vasculature, increased size and numbers of vascular sinus, absence of uterovesicle border or retroplacental hypoechoic zone, and invaded placenta insertion on myometrium. Proper planning prior to the operation and detailed counseling may be necessary, as well as hysterectomy; massive bleeding with transfusion remained the most seen complication.