Placental Abruption in a Patient with Suspected Placenta Accreta: The Critical Role of Imaging

Background: Placenta accreta spectrum (PAS) disorders are increasingly prevalent, particularly in women with prior cesarean deliveries. Concomitant placental abruption in the context of PAS presents a unique diagnostic and management challenge. Case Presentation: We report the case of a 32-year-old gravida 5, para 5 woman with a history of three cesarean deliveries, who presented with third-trimester vaginal bleeding. MRI demonstrated an anterior, low-lying placenta with preserved myometrial-placental interface in most areas, but a markedly thinned isthmic myometrium measuring 1.4 mm. A 5 cm heterogeneous T2 hyperintense collection consistent with hemorrhage was identified between the placenta and uterine wall, compressing the amniotic sac and fetus—findings suggestive of a coexisting placental abruption. No signs of extra-uterine invasion or bladder involvement were seen. Conclusion: This case underscores the vital role of MRI in evaluating suspected PAS, particularly in complex presentations with overlapping placental pathologies. MRI provides essential anatomical detail, enabling comprehensive prenatal assessment, multidisciplinary planning, and optimal peripartum management to minimize maternal-fetal morbidity.