Maternal death at 28 weeks gestation due to vascular rupture of placenta accreta

Placenta accreta spectrum (PAS) is becoming increasingly common and is associated with significant morbidity and mortality. Prenatal diagnosis and timely referral to centers have been shown to improve outcomes. We present a case of maternal death at 28 weeks of gestation due to massive internal bleeding caused by the rupture of abnormal blood vessels from placenta accreta. The diagnosis of PAS was suspected by morphological ultrasound at 23 weeks of gestation. Expectant management was decided for this patient since she had no children. The patient was transported to the emergency room at 28 weeks of gestation after having a sudden loss of consciousness without other signs (no pelvic pain, no metrorrhagia). After preliminary assessment, maternal death was noted. Hemoperitoneum associated with a placental vascular rupture was found at the autopsy. In the absence of a therapeutic consensus, this case highlights the challenges in managing pregnant women with suspected PAS disorders in the second trimester.