Presentation
Massive vaginal bleeding post dilatation and curettage for missed abortion in 2nd trimester. Difficulty in removing the placenta. Previous Cesarian section.
Patient Data
Lower uterine segment scar anteriorly associated with a hypervascular mass (arterial and venous flow) consistent with placental tissue intimately related to the scar together with echogenic clot (avascular) in the endometrial cavity and expanded endocervical canal. The degree of placental infiltration is minimal indicating accreta rather than percreta.
Case Discussion
Placenta accreta is usually associated with a lower uterine segment cesarian section (LUSCS) scar, and the history of bleeding post-delivery or D&C is typical together with difficulty in removing the placenta. Accreta indicates that infiltration of placental tissue into the myometrial wall is minimal whereas percreta indicates full thickness infiltration and is a very serious condition with potentially dire circumstances of uncontrollable bleeding.
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