A life-threatening placenta accreta in the first trimester: a rare case report

Introduction and importance: Placenta accreta is a form of abnormal placental adherence within the placenta accreta spectrum (PSA), usually diagnosed in the second or third trimester. Its occurrence in the first trimester is exceedingly rare and may lead to life-threatening hemorrhage. Case presentation: We report a 44-year-old multiparous woman with a history of two cesarean sections who presented with prolonged vaginal spotting and was initially diagnosed with a missed abortion. Following medical termination and curettage, uncontrolled hemorrhage developed, necessitating an emergency laparotomy. Intraoperative findings revealed placenta accreta, and a total hysterectomy was performed. Clinical discussion Severe hemorrhage during abortion management in a high-risk patient aligns with early PSA complications. Despite her risk profile, early imaging failed to identify abnormal placentation, demonstrating that unexpected massive bleeding is often the primary clinical indicator of this condition in the first trimester. Conclusion: This case underscores the importance of considering the PSA in patients presenting with unexplained severe bleeding in early pregnancy, particularly in those with risk factors such as prior cesarean delivery, to prevent delayed diagnosis and catastrophic outcomes.