Placenta Accreta: First Trimester Ultrasonographic Finding. Case Report

Abstract

Introduction: Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric complication characterized by abnormal trophoblastic invasion into the myometrium. While prenatal diagnosis is typically made in the second or third trimester, this case reports a suggestive sonographic detection in the first trimester, making it an uncommon clinical finding and an emerging diagnostic insight in the current medical literature. It provides evidence for the possibility of early suspicion of PAS, even in the absence of regular prenatal care, and highlights the utility of Doppler ultrasound in early pregnancy.

Case report: A 32-year-old woman, G3C1A1, with a history of cesarean section due to breech presentation and uterine curettage following spontaneous abortion, was at 13.2 weeks of gestation without formal prenatal control. Two weeks prior to hospital admission, a transvaginal ultrasound revealed an irregular myometrial-placental interface, scar fibrosis in the lower uterine segment, multiple tortuous subplacental venous lakes with irregular Doppler flow, a live fetus with a heart rate of 145 bpm, and an open cervix—findings highly suggestive of PAS. The patient later presented to the emergency department with active vaginal bleeding, moderate pelvic pain, and general malaise. On physical examination, she exhibited tachycardia, normal remaining vital signs, active trans-cervical bleeding, and cervical dilation. Due to the persistent bleeding and prior suggestive imaging findings, placenta accreta was considered the main diagnosis. A multidisciplinary consensus led to obstetric hysterectomy.

The procedure was performed under epidural anesthesia and revealed hematogenous infiltration of the myometrium and macroscopic signs of PAS in the lower uterine segment and cervix. Estimated blood loss was 300 ml, and a Penrose drain was placed. The surgery was uneventful. The patient had a favorable postoperative course, was discharged after 48 hours, and attended follow-up for pathology review, which confirmed placenta accreta with insertion over the endocervical canal.

Conclusion: This case illustrates that sonographic signs suggestive of PAS can be present as early as the first trimester, particularly in patients with risk factors such as prior cesarean delivery or uterine curettage. Early recognition through Doppler ultrasound, even without formal prenatal care, enabled rapid and effective therapeutic decision-making, reducing potential complications. Multidisciplinary management and appropriate surgical planning were key to a favorable maternal outcome. This report reinforces the need for active clinical suspicion and targeted imaging in at-risk patients during early pregnancy.