Unexpected Placenta Accreta Spectrum During Cesarean Section: Intraoperative Diagnosis and Life-Saving Surgical Management

Placenta accreta spectrum (PAS) is a major cause of obstetric hemorrhage and maternal morbidity. Despite advances in antenatal imaging, some cases remain undiagnosed until delivery. We report a case of intraoperative diagnosis of placenta accreta in a 32-year-old woman with a history of two prior cesarean sections. Following delivery of a healthy neonate, the placenta failed to separate and was found to be abnormally adherent to the uterine wall. In the setting of ongoing bleeding and absence of a cleavage plane, a subtotal hysterectomy was performed. The patient had a favorable postoperative outcome. This case underscores the importance of anticipating PAS in high-risk patients and highlights the need for rapid intraoperative decision-making when the diagnosis is unexpected.