A 34-year-old woman with a previous uterine scar presents at 32 weeks. Ultrasound shows absence of the retroplacental myometrial layer, placental lacunae, and loss of the bladder wall-uterine interface. Doppler reveals turbulent flow within lacunae. What is the correct diagnosis and recommended management?
- A Grade III placenta praevia — plan elective cesarean at 37 weeks
- B Placenta accreta spectrum (percreta) — planned cesarean hysterectomy at a tertiary centre at 34–36 weeks ✓
- C Subchorionic hematoma — expectant management
- D Vasa praevia — deliver at 35 weeks
Explanation
The ultrasound triad of absent retroplacental clear zone, placental lacunae (irregular vascular spaces with turbulent flow on Doppler), and loss of bladder wall-uterine interface is diagnostic of placenta accreta spectrum (PAS), specifically percreta (bladder involvement). Management involves multidisciplinary planned cesarean hysterectomy at 34–36 weeks at a specialist centre with interventional radiology backup (uterine artery balloon occlusion). Attempting placental removal risks life-threatening hemorrhage. Vasa praevia shows vessels over the internal os, not placental lacunae.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.