A multiparous patient undergoes cesarean section for placenta previa. During surgery, the placenta does not separate on its own and manual attempts at separation result in massive bleeding. MRI done antenatally had shown loss of the retroplacental clear zone. What is the MOST likely diagnosis and definitive management?

• A Placenta accreta spectrum; hysterectomy ✓
• B Placenta increta; uterine curettage
• C Placenta percreta; uterine artery embolization
• D Velamentous cord insertion; manual removal and repair

Explanation

Placenta accreta spectrum (PAS) disorder is characterized by abnormal invasion of the myometrium by placental villi. Loss of the retroplacental clear zone on MRI and ultrasound features (lacunae, loss of hypoechoic zone) are diagnostic. In accreta (superficial invasion), increta (deep myometrial), and percreta (through serosa), the definitive and often life-saving management is cesarean hysterectomy with the placenta left in situ rather than forced removal, which causes catastrophic hemorrhage.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.