August 2018 · Volume 7 · Issue 8 Page 3417 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Chanu SM et al. Int J Reprod Contracept Obstet Gynecol. 2018 Aug;7(8):3417-3419 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Successful management of total placenta previa with placenta accreta presenting with massive obstetric hemorrhage: a case report Sairem Mangolnganbi Chanu 1 , Biswajit Dey 2 *, Samarjit Dey 3 , Khairul Hadi 3 , Nalini Sharma 1 , Vandana Raphael 2 INTRODUCTION Placental disorders are disorders which occur during attachment of the placenta to the uterine wall. 1 Placental disorders such as placenta previa and placenta accreta are associated with vaginal bleeding. 2 The prevalence of these disorders is estimated to be around 0.3 %. 1 Placenta accreta is present when there is excessive invasion during placentation extending beyond the decidua basalis. When the placental invasion is deep into the myometrium, this is known as placenta increta. When the placental penetration is along the entire thickness of uterine wall and reaches the serosa, this is known as placenta percreta. 1 Placental disorders also include low-lying placenta (placental edge closest to the cervix < 2 cm from the inner os), marginal placenta previa (placenta extends to the edge of the cervix), partial placenta previa (a portion of the cervix is covered by the placenta), and total placenta previa (inner os completely covered by the placenta). 1 Both these placental disorders, i.e. placenta previa and placenta accreta are associated with increased maternal and fetal morbidity and mortality. 3 Authors report a case of total placenta previa with placenta accreta in a 39-year-old female in the 32nd week of pregnancy. CASE REPORT A 39-year-old female with gravida 2 and para 1 presented with lower abdominal pain at 32+2 weeks of pregnancy. She had a history of prior lower segment cesarean section three years earlier. A diagnosis of total placenta previa was made following examination on admission. She was advised complete bed rest and oral magnesium sulphate. Abdominal ultrasonography (USG) showed an intact singleton pregnancy appropriately developed for age. Cervical length on vaginal sonography was 35 mm without funnelling. The placenta covered the inner os. Ultrasonography (USG) raised the suspicion of placenta accreta. Magnetic resonance imaging (MRI) was advised however, she complained of massive bleeding per vaginum and was rushed to the emergency. Her blood pressure was 70/50 ABSTRACT Placenta previa and placenta accreta are important causes of serious fetal and maternal morbidity and even mortality necessitating hysterectomy. We report a case of total placenta previa with accreta in a 39-year-old female in the 32+2 weeks of pregnancy with successful delivery by cesarean. However, hysterectomy was performed to control postpartum hemorrhage. Keywords: Hemorrhage, Hysterectomy, Placenta 1 Department of Obstetrics and Gynecology, 2 Department of Pathology, 3 Department of Anesthesiology, NEIGRIHMS, Shillong, Meghalaya, India Received: 06 June 2018 Accepted: 29 June 2018 *Correspondence: Dr. Biswajit Dey, E-mail: drbish25@rediffmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20183359