Unusual Presentation of Placenta Accreta Spectrum with Gastrointestinal Problems at ۲۷ Weeks of Gestation: A Case Report

Placenta Accreta Spectrum (PAS) is a severe obstetric complication characterized by abnormal placental adherence or invasion into the myometrium, potentially extending to adjacent organs. This condition poses significant maternal and fetal risks, including life-threatening hemorrhage, and often necessitates complex surgical interventions, such as cesarean hysterectomy. Early diagnosis, coupled with multidisciplinary management, is essential to improve outcomes. Here, we reported a ۳۲-year-old gravida four pregnant woman at ۲۷ weeks of gestation with acute abdominal pain, nausea, and vomiting who was referred to our emergency department. She had these symptoms from the day before, which were increasing. Her primary vital sign was blood pressure: ۹۰/۶۰ mmHg, heart rate: ۱۰۴, respiratory rate: ۲۸ per minute, temperature: ۳۶.۵ °C, and her physical examination revealed a distended abdomen with general tenderness. With the worsening of its general condition, she was transferred to the operating room about three hours after the patient entered the emergency department. Emergency laparotomy confirmed placenta increta with extensive uterine and bladder invasion. A live neonate was delivered, and a total abdominal hysterectomy was performed. The woman was admitted for three days to the ICU and then three days in the women's ward, and she was discharged in good general condition about one week after being referred to the emergency department. This case underscores that PAS should be on the list of differential diagnoses of unstable hemodynamic situations in pregnant women with a history of previous cesarean delivery, even in cases with unrelated presentation.

Keywords:

placenta accreta spectrum , Hemoperitoneum , Second Trimester Presentation , Cesarean Hysterectomy , Maternal-Fetal Outcomes