The first clinical manifestation of placenta accreta spectrum (PAS) is life-threatening excessive bleeding, which usually occurs during manual placental separation. However, it can also occur as antenatal hemorrhage in the setting of placenta previa.
The pregnant woman with a history of two previous cesarean sections was referred to the Obstetrics and Gynecology clinic with clinical findings of macroscopic hematuria. Fetal biometric measurements in the ultrasonographic evaluation were compatible with 26 weeks of gestation. The placental location was on the lateral wall of the uterus and there was no placenta previa. On the 4th day of the clinical follow-up, the patient with persistent hematuria was examined with cystoscopy and magnetic resonance imaging (MRI). In the MRI evaluation, it was determined that the placenta was located in the lateral walls of the uterus as two separate components and it was suspicious for the velamentous placenta, and the myometrium was thinned at the level of the left lateral placenta. However, placental invasion anomaly was not considered. On the 14th day of the follow-up, the patient, whose hematuria decreased and improved, was discharged from the outpatient clinic. The pregnant woman applied to the emergency service with labor at 36 weeks of gestation. The pregnant woman was operated on urgently. Placenta invading the uterine lateral wall and bladder was left in place and a peripartum hysterectomy was performed.
There is a risk of placental invasion in cases with previous uterine surgery and hematuria, regardless of imaging methods.
Anahtar Kelimeler: Placenta accreta spectrum, Velamentous placenta, Hematuria