A 34 year old woman with two previous lower segment cesarean sections presents at 32 weeks with painless vaginal bleeding. Ultrasound shows a complete placenta previa covering the os with loss of the retroplacental clear zone, multiple lacunae, and abnormal uterovesical vascularity. Which statement is most accurate?

• A Vaginal delivery after expectant management is safe once bleeding settles
• B Planned cesarean hysterectomy with multidisciplinary team involvement is the appropriate strategy ✓
• C Attempted manual removal of the placenta at cesarean is preferred to conserve the uterus
• D MRI adds nothing once ultrasound findings suggest accreta spectrum disorder

Explanation

Placenta previa combined with prior cesarean sections is the classic setting for placenta accreta spectrum, and the lacunae, lost clear zone and neovascularity confirm invasion. Delivery at a centre with blood bank, interventional radiology and urology support, usually around 34 to 36 weeks, with planned hysterectomy if invasion is confirmed, minimises morbidity. Manual extraction provokes catastrophic haemorrhage. MRI complements rather than replaces ultrasound in equivocal posterior or parametrial invasion.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.