A patient at 30 weeks with a previous lower segment caesarean section presents with painless bright-red vaginal bleeding. Ultrasound shows anterior placenta praevia with loss of the clear zone between placenta and myometrium and multiple lacunae. The MOST likely diagnosis is:

• A Placenta praevia without accreta
• B Placenta percreta
• C Vasa praevia
• D Placenta accreta spectrum — accreta type ✓

Explanation

Loss of the retroplacental clear zone (hypoechoic myometrial zone) on ultrasound combined with irregular lacunae ('moth-eaten' placenta) in a patient with prior caesarean section and anterior praevia is the classic ultrasound signature of placenta accreta spectrum. Percreta would additionally show bladder invasion on colour Doppler or MRI. Vasa praevia presents with fetal heart rate changes at membrane rupture.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.