Evolving Cesarean Scar Pregnancy into Morbidity Adherent Placenta—Evidence from Serial Ultrasound Examination

Abstract

Objective:To present the complete history of a case with placenta accreta and demonstrate the special clues of ultrasonography finding during whole trimesters from early pregnancy to delivery.Case Report:A multiparous 28-year-old female with a history of multiple cesarean deliveries was found with suspected precesarean section scar pregnancy at 6 weeks of gestation. We performed a series of ultrasonography scans, which revealed placenta previa totalis and placenta accreta at 15 and 32 weeks of gestation, respectively. A well-planned cesarean section with hysterectomy was performed at the 35th week of gestation with massive blood transfusion support, and an alive female baby—with a birth body weight of 2485 g, and Apgar score of 9 at the 1st minute and 10 at the 5th minute—was born. The intraoperative blood loss was 7000 mL, and no postoperative hemorrhage or other complication occurred.Conclusion:Ultrasonography remains the main tool for diagnosis of morbid adherent placenta with several typical clues, including abnormal vasculature, increased size and numbers of vascular sinus, absence of uterovesicle border or retroplacental hypoechoic zone, and invaded placenta insertion on myometrium. Proper planning prior to the operation and detailed counseling may be necessary, as well as hysterectomy; massive bleeding with transfusion remained the most seen complication.

Frequency of Morbidly Adherent Placenta in Previous Scar

“…The only possible justification of this may that in fresher scars the granulation tissue and scar itself may be a feasible or attractive site for MAP while the older scars may have changed physiologically so much that it would not favor the development of MAP and can be further examined. According to literature, the earliest gestation at which placenta accreta had been diagnosed by ultrasound was 9 weeks in a case of scar pregnancy [18][19][20] . Vijayasree M 2018 21 in the study, revealed sonography was only 33-percent sensitive for detecting placenta accrete.…”

MRI Assessment of Cesarean Scar Pregnancies: A Case Series

“…However, it has been reported that, especially at earlier stages, CSP may be only mildly symptomatic, with no typical clinical findings, resulting in a late diagnosis and treatment and more severe outcomes [20]. Thus, to avoid a delayed or missed diagnosis and to improve diagnostic efficiency, TVUS is usually performed at early pregnancy stages in patients with an history of previous uterine surgery or cesarean sections [21,22]. The sensitivity of TVUS for diagnosing cesarean scar pregnancies is reported to be 84.6% [23], and it is still the preferred imaging method.…”

Diagnosis and Treatment of Intramyometrial Placental Tissue Invasion in Cesarean Scar: A Case Report

“…No clear treatment guidelines have been suggested for the treatment of Morbidly Adherent Placenta. It has been shown that if cesarean scar pregnancy is complicated with morbidly adherent placenta (cesarean scar adherent placental tissue invasion), the most frequently therapeutic approach is hysterectomy [9].…”