A case report of a first trimester missed abortion which unfolded into an emergency subtotal hysterectomy

Placenta Accreta Spectrum (PAS) encompasses various degrees of abnormal placental attachment, where the decidual basalis is compromised, allowing chorionic villi to invade into or beyond the myometrium. This invasion is difficult to diagnose in first trimester ultrasound. PAS results in incomplete separation of the placenta and subsequent hemorrhage which can be life threatening to the mother. We present a case of a woman with previous two LSCS presenting in first trimester with missed abortion wherein a Manual Vaccuum Aspiration was followed by uncontrollable hemorrhage necessitating a hysterectomy and a retrospective diagnosis of placenta increta. The primary modality of imaging in first trimester -the ultrasound - is not reliable to diagnose placenta accreta syndrome and additional inputs may be needed to make this diagnosis in the first trimester