Placenta Accreta Spectrum in a Patient Without Prior Cesarean Delivery: A Case of Posterior Placenta Previa

Placenta accreta spectrum (PAS) is a potentially fatal obstetric condition characterized by abnormal placental adherence to the myometrium. It is strongly associated with prior cesarean delivery or major uterine surgery; however, a minority of cases occur in patients without these histories. We report the case of a 34-year-old, gravida 3, para 2 (G3P2002) woman with no history of cesarean delivery and only a prior dilation and curettage, who presented at 32 weeks and 3 days of gestation with complete posterior placenta previa and imaging findings concerning for PAS. Ultrasonography revealed placental lakes and increased vascularity, while magnetic resonance imaging (MRI) demonstrated indistinct retroplacental myometrium with focal uterine bulging. The patient was counseled regarding risks, including hemorrhage, transfusion, and hysterectomy. A multidisciplinary care plan was established for cesarean hysterectomy at 34 weeks of gestation, with coordination among maternal-fetal medicine, anesthesiology, neonatology, general surgery, transfusion medicine, and intensive care services. This case highlights that PAS can present in women lacking traditional risk factors and that posterior placenta previa may pose additional diagnostic challenges, underscoring the need for heightened vigilance and multidisciplinary planning to optimize outcomes.