Clinical Challenges in Managing an Adherent Placenta Without Myometrial Invasion: A Case Report

Background: Placenta previa is a known cause of antepartum haemorrhage and can be complicated by abnormal placental adherence. Placenta Accreta Spectrum (PAS) is typically suspected when the placenta fails to separate during cesarean delivery, but not all cases of adherent placenta represent true PAS. Case Presentation: We report a case of a 24-year-old primigravida at 38 weeks of gestation who presented with vaginal bleeding and was diagnosed with complete placenta previa. During cesarean delivery, the placenta failed to detach spontaneously and was firmly adherent to the lower uterine segment and posterior uterine wall. Attempts at piecemeal removal left residual tissue, resulting in severe haemorrhage. Haemostatic sutures, uterine artery ligation, and bilateral internal iliac artery ligation were performed, but bleeding persisted, necessitating a life-saving cesarean hysterectomy. Estimated blood loss was 3500 mL, requiring multiple blood component transfusions. Gross examination revealed extensive placental adherence to the posterior uterine wall, lower segment, and cervix. Histopathology showed no chorionic villi invading the myometrium, ruling out placenta accreta spectrum. Conclusion: This case highlights that significant placental adherence causing life-threatening haemorrhage can occur even in the absence of PAS. Clinicians should be prepared for massive obstetric haemorrhage and complex surgical interventions in such scenarios, despite the lack of histopathological myometrial invasion.