Early Ultrasound Diagnosis of Placenta Accreta: A Case Report

Background: With the rising rate of cesarean section, there has been an increase in the incidence of abnormal placentation in subsequent pregnancies, leading to the clinical complications of placenta accreta (PA) and cesarean scar ectopic pregnancies. The majority of cases of PA are unexpected and initially identified intraoperatively or during third trimester ultrasound. Case: A 38-year-old G3P1011 with a previous low transverse lowersegment cesarean delivery who conceived using letrozole/IUI had an initial viability ultrasound at 5 weeks 5 days which was suspicious for an early placenta accreta versus cesarean scar pregnancy. Subsequent serial ultrasounds revealed placental lakes, a moth eaten appearance, and increased vascularity, concerning for placenta accreta. Results: She underwent a repeat cesarean section with a high vertical incision during which placenta was found to be adherent to the uterus and the decision was made to proceed with hysterectomy. Placental pathology showed a mature placenta with extensive placenta increta and focal placenta percreta involving the right lateral uterus in addition to a complete placenta previa. She experienced a 7L blood loss requiring 6 units of pRBC and was managed in the ICU for 4 days until progressing to discharge along with a healthy 3.2kg male infant. Conclusion: Our case represents a unique case in which a placenta accreta was detected by transvaginal ultrasound in a woman at 5 weeks and 5 days gestation who conceived with the assistance of intrauterine insemination. To our knowledge, this is the earliest case of suspected placenta accreta by ultrasonography.