EP16.50: Unusual presentation of placenta accreta spectrum isolated to the cervix

Diagnosing placenta accreta spectrum (PAS) involves many challenges and difficulties. Despite the centre's radiological capabilities and experience, it sometimes is detected in the operating room. In the rare case report, cervical involvement in PAS creates diagnostic difficulties which lead to emergency hysterectomy. A 33-year-old women in her 27th week of third pregnancy was admitted to university hospital due to vaginal spotting and placenta previa suspicion. Her medical history was uneventful apart from 1 Caesarean section performed 3 years ago prior for intrapartum indications. During her 5-day hospitalization, vaginal spotting ceased, placenta previa was confirmed, and expert ultrasound excluded PAS. The patient was discharged with recommendations to immediately return to hospital if vaginal bleeding occurred and to be admitted after 34 weeks' gestation. Seven weeks later, at 34 weeks' gestation the patient was readmitted for vaginal bleeding and first stage of labour. Due to the suspicion of premature placental abruption, the patient was qualified for an emergency Caesarean section. A stable newborn with an Apgar score of 9/9/10 and a weight of 2460g was delivered. Macroscopically the lower uterine segment was purple and thin, and PAS was suspected. Spontaneous placental delivery was impossible, so manual delivery proceeded with difficulty in the previa fragment where the structure of uterus was uneven and villi-like. Surgeon attempted conservative treatment, with no effect. Cervical bleeding resulted in an estimated blood loss of 1500ml and an emergency hysterectomy was performed. Blood transfusion was initiated in the operating room and continued in recovery. The postoperative course was uneventful and patient was discharged after 12 days. Histopathological examination confirmed focal placenta accreta in the cervix. Placenta previa after Caesarean section may require additional magnetic resonance imaging despite expert ultrasound.