SUSPICION OF PLACENTA ACCRETA IN CASE OF PLACENTA PRAEVIA WITH RISK FACTORS

Placenta accreta incidence has increased tenfold due to increasing number of caesarean sections.30 year old G5P3L2A1 Previous 2LSCS,LMP on16.12.13 and EDD on 23.09.2014 admitted with complaints of bleeding per vaginum for past 1 day.Patient afebrile, mild pallor,Abdomen-Uterine size corresponding to 34 weeks, not acting, head mobile,FHR was good, no bleeding per vaginum. CBC, RFT, LFT, bleeding time ,clotting time and Coagulation profile were normal. USG revealed Single Live Intrauterine Gestation with cephalic presentation corresponding to 34 weeks, Liquor adequate, FHR is good, Placenta is central completely covering the OS. MRI Pelvis revealed Gravid Uterus, single term fetus with complete placenta praevia with focal bulge in the posterior wall with loss of myometrial hypointense border suggesting placenta accrete. Antenatal steroid course given, due to another bout of bleeding, Emergency LSCS with total in situ hysterectomy done. The placenta was central completely covering the OS and does not separate after baby delivery and hence proceeded with insitu hysterectomy. Baby is alive, preterm alive and healthy, postoperative period was uneventful. Conclusion Women with previous caesarean scar found to have a placenta praevia especially anterior should suspect accreta. MRI used especially in posterior placenta to rule out local invasion and invasion into the adjacent structures.