Unexpected Dramatic Evolution of Placenta Increta: Case Report and Literature Review

Abstract

Placental morbid adherence is a known risk factor for postpartum hemorrhage. The incidence of abnormal placental attachment has been increasing over the past few decades, mainly due to rising rates of cesarean deliveries, advanced maternal age, and the use of assisted reproductive technologies. Cesarean section is a significant risk factor for placenta increta, as it disrupts the normal architecture of the uterine wall, making it more difficult for the placenta to detach after delivery. We present the case of a woman who underwent a cesarean section at 28 weeks due to anterior placenta previa, accompanied by hemorrhage and rupture of membranes. Following the delivery, she experienced normal postoperative bleeding and was discharged home after five days. However, six weeks later, she presented with heavy bleeding, leading to the decision to perform a total hysterectomy. The levels of HCG were found to be low. The pathological examination of the specimens confirmed a diagnosis of placenta increta, as it revealed notable placental proliferation, necrotic villi, and placental invasion near the uterine serosa. Notably, we did not find any similar cases documented in the literature. Patients experiencing prolonged vaginal bleeding after childbirth and diagnosed with placenta accreta should be closely monitored through ultrasound examinations; abnormal proliferation of the placenta can occur, and prompt detection is crucial for appropriate management.

Keywords: cesarean section; placenta increta; postpartum hemorrhage.

Figure 1

The normal aspect of the uterine body.

Figure 2

The mass located in the inferior part of the uterus and the upper part of the cervical channel.

Figure 3

The mass with increased vascularity.

Figure 4

The lower part of the uterine cervix with normal characteristics.

Figure 5

The mass is located in the inferior part of the uterus.

Figure 6

Posterior rupture of the uterus with visualization of the mass.

Figure 7

Chorionic villus without decidua in the thickness of the myometrium, hematoxylin and eosin stain, ×10.

Figure 8

Placenta with aspects of accretion-muscle fibers colored in red on the right of the image, Van Gieson stain, × 20.

Figure 9

Chorionic villi in the endocervical region, in the left endocervical mucosa, hematoxylin and eosin stain, × 4.

Figure 10

Necrotic chorial villi (A) included in fibrino-leucocytic exudate (B) in the vicinity of the large vessels in the external half of the wall, hematoxylin and eosin stain, × 4.