Placenta Accreta Spectrum (PAS) is an increasingly recognized, potentially life-threatening pregnancy complication where the placenta abnormally attaches too deeply into the uterine wall, posing risks of severe hemorrhage due to improper detachment after childbirth. While previous Cesarean deliveries are a significant risk factor, other contributing factors include placenta previa, uterine surgeries, advanced maternal age, and multiple pregnancies, with early detection through advanced imaging like ultrasound and MRI being crucial for better patient outcomes. A challenging case highlighted the severity of PAS, involving a 40-year-old woman at 17 weeks of gestation with placenta percreta invading her bladder, necessitating an emergency hysterectomy and bladder repair, underscoring the importance of expectant mothers sharing their medical history and seeking immediate emergency care for concerning symptoms, as multidisciplinary teams and timely interventions can lead to successful maternal recovery.

Placenta Accreta Spectrum (PAS) is an increasingly recognized, potentially life-threatening pregnancy complication where the placenta abnormally attaches too deeply into the uterine wall, posing risks of severe hemorrhage due to improper detachment after childbirth. While previous Cesarean deliveries are a significant risk factor, other contributing factors include placenta previa, uterine surgeries, advanced maternal age, and multiple pregnancies, with early detection through advanced imaging like ultrasound and MRI being crucial for better patient outcomes. A challenging case highlighted the severity of PAS, involving a 40-year-old woman at 17 weeks of gestation with placenta percreta invading her bladder, necessitating an emergency hysterectomy and bladder repair, underscoring the importance of expectant mothers sharing their medical history and seeking immediate emergency care for concerning symptoms, as multidisciplinary teams and timely interventions can lead to successful maternal recovery.

Placenta Accreta Spectrum (PAS) is an increasingly recognized, potentially life-threatening pregnancy complication where the placenta abnormally attaches too deeply into the uterine wall, posing risks of severe hemorrhage due to improper detachment after childbirth. While previous Cesarean deliveries are a significant risk factor, other contributing factors include placenta previa, uterine surgeries, advanced maternal age, and multiple pregnancies, with early detection through advanced imaging like ultrasound and MRI being crucial for better patient outcomes. A challenging case highlighted the severity of PAS, involving a 40-year-old woman at 17 weeks of gestation with placenta percreta invading her bladder, necessitating an emergency hysterectomy and bladder repair, underscoring the importance of expectant mothers sharing their medical history and seeking immediate emergency care for concerning symptoms, as multidisciplinary teams and timely interventions can lead to successful maternal recovery.

Pregnancy is always a unique experience for every woman, but even when most pregnancies are generally healthy, some conditions can become life-threatening. One such condition is Placenta Accreta Spectrum (PAS)—an uncommon but increasingly recognised pregnancy complication in which the placenta grows too deeply into the wall of the uterus instead of attaching to its inner lining.

Awareness of PAS is becoming essential for Indian women. Better access to prenatal imaging and improved maternal health care mean the condition is being identified earlier than before. While previous caesarean deliveries are among the strongest risk factors, they are not the only cause, and women should not view C-sections as inherently unsafe. Many are medically necessary and life-saving for both mother and baby.

What causes placenta accreta spectrum?

Placenta accreta spectrum arises due to the abnormal attachment of the placenta deeply into the wall of the uterus. Depending upon the depth of implantation, it can be either placenta accreta, increta, or placenta percreta, which is the severest form where the placenta penetrates through the uterine wall and may involve nearby organs such as the urinary bladder.

Besides previous caesarean deliveries, other factors that may increase the risk include placenta previa (where the placenta covers the cervix), previous uterine surgeries such as fibroid removal, repeated dilation and curettage (D&C) procedures, scarring inside the uterus, advanced maternal age and multiple previous pregnancies. The condition is often detected through ultrasound or MRI, enabling doctors to plan treatment well in advance.

Why early diagnosis can save lives

Early diagnosis is extremely important as PAS can cause life-threatening hemorrhage because the placenta will not detach properly following childbirth. In later stages of the condition, even other nearby organs like the bladder may get affected and complicate things for the patient. But with early diagnosis and proper planning for delivery, as well as multidisciplinary management involving a range of doctors and support facilities, the outlook becomes much better.

A rare emergency at just 17 weeks of pregnancy

One of the most challenging examples involved a 40-year-old woman from rural Madhya Pradesh, who was pregnant with her third child and presented during her 16th week of pregnancy. She had a history of two previous caesarean deliveries and had been diagnosed with placenta percreta, where the placenta had grown through the uterine wall and invaded the urinary bladder. 

An MRI confirmed extensive placental invasion into the bladder, and a multidisciplinary team counselled the patient and her family regarding the significant risks while planning further management. Before the planned intervention, however, she developed sudden severe abdominal pain and arrived at the emergency department in haemorrhagic shock due to internal bleeding.

She was immediately taken up for emergency surgery. During the three-hour procedure, doctors confirmed extensive placental invasion into the bladder. A life-saving hysterectomy was performed to control the haemorrhage, followed by meticulous bladder repair. The patient also required massive blood transfusion support. The case was particularly notable because such severe complications occurred at just 17 weeks of pregnancy, much earlier than is typically seen. Following intensive care, she recovered steadily and was discharged in stable condition with a temporary urinary catheter to support bladder healing.

What should expectant mothers be mindful of?

This message is to create awareness for Indian women to overcome their pregnancy fears and medical C-section anxieties, while they should focus on their regular antenatal check-ups and they need to share their past uterine operations and pregnancy issues with their health care provider.

Experts need to diagnose every condition without delay because pregnant women who experience severe abdominal pain or heavy bleeding or dizziness or fainting must seek emergency medical care.  Placenta Accreta Spectrum appears as a rare condition, which, in this case, shows that experts can handle complex pregnancies through early detection and modern imaging technology and proper scheduling and team-based medical collaboration to achieve optimal maternal recovery and give women the best possible chance of a safe recovery.

( Dr Ashwini Neelakanthi is a Consultant – Obstetrics and Gynaecology and Dr Chethan JV is a Consultant – Urology, Manipal Hospital, Varthur Road)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.

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