A 35-year-old woman with two previous cesarean sections undergoes ultrasound at 20 weeks. The placenta is anterior, low-lying, and Doppler shows loss of retroplacental clear space with intraplacental lacunae and hypervascularity of the bladder–uterine interface. The MOST likely diagnosis and its sub-type is:

• A Placenta accreta spectrum — increta
• B Placenta praevia type IV with vasa praevia
• C Placenta accreta spectrum — accreta
• D Placenta accreta spectrum — percreta ✓

Explanation

Hypervascularity at the bladder–uterine interface on Doppler, combined with loss of retroplacental clear space and irregular intraplacental lacunae, are characteristic ultrasound features of placenta percreta, where villi invade through the myometrium into adjacent organs (bladder in this case). Increta invades the myometrium but not through it; accreta is superficial adherence without invasion. Prior cesarean scars are the strongest risk factor.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.