Early Pregnancy Invasive Placenta – Late Presentation: Case Report and Review of Literature

Introduction: Placenta percreta is the severe form of morbidly adherent placenta (MAP) where chorionic villi penetrate through the myometrium and to or through the serosa involving bladder or bowel in some cases and can be associated with severe complications.

Case Presentation: In our present case we had a 30-year-old, Gravida 4, Para 2 Living 2 Abortion 1 with previous 2 caesarean sections, present with bleeding on and off since 3 months, post spontaneous abortion at 13+ weeks followed by incomplete check curettage. On examination she was found to have a boggy mass per vagina and a serum Beta-Human Chorionic Gonadotropin (BHCG) value was slightly above normal. On imaging and evaluation she was found to have a mass occupying the lower uterine cavity invading the myometrium with significant vascularity, reported as invasive mole provisionally. She was taken up for laparotomy and hysterectomy after counselling in detail and correction of anemia. Intra-operatively a ballooned out lower uterine segment with a vascular mass was noted which was partially invading the bladder wall. Patient had an uneventful post op period. Her final histopathology report showed placenta percreta with few viable chorionic tissue

Discussion: Morbidly adherent placenta in early pregnancy can be tricky to diagnose and manage. Patient antenatal history of previous 2 caesarean sections and low-lying placenta in index pregnancy and a failed curettage gave us important clues to her diagnoses along with the MRI findings and BHCG values. Hysterectomy seemed best option for her.

Conclusion: High index of suspicion and planning is required to manage placenta percreta cases successfully.