Abstract

Maternal and fetal morbidity and mortality from placenta accreta are considerable. Most cases of placenta accreta have known risk factors and are diagnosed antenatally. They are often delivered by elective caesarean section. Only a handful of cases of placenta accreta in low risk primiparous women have been reported in the literature.

Our case is unusual as it was diagnosed following a vaginal delivery in a young, low risk primip with no known risk factors for adherent placenta. A manual removal of placenta was unsuccessfully attempted for retained placenta. A postnatal USS and MRI were performed. MRI showed a fundal placenta accreta. She was subsequently managed conservatively with prophylactic antibiotics and serial MRI scans, as per the RCOG Green Top guideline number 27. The patient declined methotrexate due to her wish to breastfeed. She was warned of the risks of major haemorrhage and infection, including the possibility of an emergency hysterectomy. A repeat MRI, 8 weeks, later showed complete resolution of the placenta.

This case illustrates a successful outcome with conservative management using appropriate imaging modalities and counselling. This has potential implications for management of other pregnancies in the future as the recurrence rate for placenta accreta is high. Due to the changes in maternal age and increasing risk factors, the incidence and the associated complications are likely to continue to rise.