Garg Priyanka, Semwal Shweta, Bansal Romi
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
Department of Obstetrics and Gynaecology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, 151001, India.
BMC Pregnancy Childbirth. 2025 Jan 8;25(1):14. doi: 10.1186/s12884-025-07140-y.
Placenta accreta spectrum (PAS) disorder is a fatal condition responsible for obstetric haemorrhage, which contributes to increased feto-maternal morbidity and mortality. The main contributing factor is a scarred uterus, often from a previous cesarean delivery, myomectomy, or uterine instrumentation. The occurrence of PAS in an unscarred uterus is extremely rare, with only anecdotal cases reported so far in the literature. We document one such case of unexpected placenta increta without identifiable risk factors presenting with severe postpartum hemorrhage. The management is often challenging, especially in low-middle-income countries like India with limited access to healthcare, where most cases are identified only at the time of delivery.
We narrate a case of a 25-year-old woman of North Indian ethnicity, para 2 live 2, who presented to our emergency in shock with retained placenta and severe postpartum haemorrhage. She had undergone a normal vaginal delivery at 37 weeks and 2 days of pregnancy at a local hospital around 2 h before. The patient had not undergone antenatal checkups or sonography during her pregnancy. Manual removal of the placenta was attempted under anaesthesia, which was unsuccessful. So, keeping the diagnosis of the morbidly adherent placenta in mind and the deteriorating condition of the patient, an emergency laparotomy followed by a supracervical hysterectomy was performed after the conservative methods failed to control the haemorrhage. Simultaneously, she was given four units of packed red cells and fresh frozen plasma in a ratio of 1:1, along with vasopressors and fluid replacement therapy to attain hemodynamic stability. Post-operatively, the patient was shifted to the intensive care unit (ICU) for close monitoring. She was discharged after five days in satisfactory condition. A histopathological examination later on revealed placenta increta.
Although very rare, PAS in an unscarred uterus with no other known risk factors is associated with a significant rate of maternal morbidity and mortality. This case highlights the importance of screening for radiological signs of adherent placenta during prenatal visits, even in low-risk populations. Any patient suspected of PAS should be referred to a well-equipped centre for optimal care. Also, young obstetricians should be imparted skill-based training to manage such emergencies with a multidisciplinary team approach.
胎盘植入谱系障碍（PAS）是一种导致产科出血的致命疾病，会增加母婴发病率和死亡率。主要促成因素是子宫瘢痕，通常源于既往剖宫产、子宫肌瘤切除术或子宫手术操作。PAS在无瘢痕子宫中极为罕见，迄今为止文献中仅报道过个别病例。我们记录了这样一例意外发生的胎盘植入病例，患者无明确危险因素，却出现了严重的产后出血。其治疗往往具有挑战性，尤其是在像印度这样医疗资源有限的中低收入国家，大多数病例直到分娩时才被确诊。
我们讲述一例25岁北印度裔女性的病例，孕2产2，因胎盘残留和严重产后出血休克被送至我院急诊科。她在大约2小时前于当地一家医院经阴道顺产，孕周为37周零2天。该患者孕期未进行产前检查或超声检查。在麻醉下尝试手动剥离胎盘，但未成功。因此，考虑到胎盘植入的诊断以及患者病情恶化，在保守方法无法控制出血后，实施了急诊剖腹手术，随后进行了次全子宫切除术。同时，按1:1比例给予她4单位浓缩红细胞和新鲜冰冻血浆，并给予血管加压药和液体替代疗法以维持血流动力学稳定。术后，患者被转至重症监护病房（ICU）进行密切监测。五天后她状况良好出院。后来的组织病理学检查显示为胎盘植入。
尽管极为罕见，但无其他已知危险因素的无瘢痕子宫中的PAS与较高的孕产妇发病率和死亡率相关。该病例凸显了产前检查时筛查胎盘植入放射学征象的重要性，即使是在低风险人群中。任何疑似PAS的患者都应转诊至设备完善的中心接受最佳治疗。此外，应向年轻产科医生提供基于技能的培训，以便采用多学科团队方法处理此类紧急情况。
