Non-Previa Placenta Accreta Spectrum in a Woman with Previous Cesarean Section: A Case Report and Review of Pathogenesis, Etiology, and Management Perspectives

Introduction: Placenta accreta spectrum (PAS) represents a significant contributor to maternal mortality, primarily as a result of severe postpartum hemorrhage. The most prominent risk factors associated with PAS are the placenta previa and a history of cesarean delivery. Nevertheless, a normal location of placenta does not exclude PAS, although this is underreported. Case Report: We report a G3P2L0 female who was booked with us since her first trimester and had two previous cesarean deliveries, but with no live issue. During her elective lower segment cesarean section at term with all routine preparations, the placenta did not separate with the routine prophylactic dose of oxytocin, even though placenta was placed fundally. Non-separation of the placenta with a well-contracted uterus led us to consider manual removal of the placenta; however, no plane of cleavage was felt or seen, raising a suspicion of the placenta accreta syndrome. As we were at a secondary care setup without any ICU and blood bank facility, given no postpartum hemorrhage, a decision to leave the placenta in situ was taken, and the patient was shifted to a tertiary care setup for observation. She underwent an emergency hysterectomy at the referral center. Conclusion: In non-previa PAS cases, guidelines for management, tools for early suspicion and management when encountered as a surprise, and research toward its pathogenesis have a long way to go. Conservative management, particularly in uterine body PAS and resource-limited settings, with leaving the placenta in situ, should be strongly considered.