Managing Placenta Accreta Spectrum: Diagnosis, Surgical Strategies, and Postoperative Care

Placenta accreta spectrum (PAS) refers to a group of disorders characterized by abnormal trophoblastic invasion of the uterine wall, which can result in life-threatening complications such as severe hemorrhage and the need for hysterectomy. A 30-year-old female patient with a history of two prior cesarean sections and diagnosed with Grade IV placenta previa at 34+0 weeks gestation was referred to our hospital for management. The patient presented with antepartum hemorrhage and was at elevated risk for PAS due to her previous cesarean sections and placenta previa. Ultrasound findings suggested PAS, including hypervascularity, consistent with trophoblastic invasion. Elective cesarean section was performed, and intraoperatively, focal accreta was identified with manual removal of the placenta and bilateral uterine artery ligation to control hemorrhage. Histopathology confirmed myometrial tissue with hemorrhage and dilated blood vessels, consistent with PAS, but without evidence of malignancy. The patient was managed in a multidisciplinary setting and received postoperative care for bleeding complications related to Factor 12 deficiency. Her recovery was uneventful, and she was discharged on postoperative day 3. This case highlights the importance of early diagnosis, imaging, and multidisciplinary management in optimizing maternal and fetal outcomes in PAS.