May 2022 · Volume 11 · Issue 5 Page 1588 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Kumari O et al. Int J Reprod Contracept Obstet Gynecol. 2022 May;11(5):1588-1591 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Incidentally diagnosed placenta accreta managed conservatively in a primigravida: case report and review of literature Om Kumari 1 , Amrita Gaurav 2 *, Kavita Khoiwal 2 , Anshu Gupta 1 , Dhriti Kapur 2 , Rashmi Halder 2 , Jaya Chaturvedi 2 INTRODUCTION Placenta accreta spectrum (PAS) is a potential life- threatening condition. Incidence of Placenta previa has risen considerably following rise in rate of Caesarean delivery (CD), which in turn have also increased the incidence of PAS. Most cases of PAS have placenta previa, prior CD or combination of both but accreta placentation in primiparous women without recognised risk factors like prior uterine surgery, operative hysteroscopy, assisted reproductive technology, submucosal leiomyoma, endometritis or uterine malformations or any procedure causing surgical damage to endometrial integrity is exceedingly rare. These risk factors raise high index of suspicion and allows for careful sonographic examination of placenta to look for any evidence of PAS. Prenatally, unsuspected PAS is often associated with massive obstetric haemorrhage during attempts to remove the placenta manually from uterine wall. Literature shows few cases of primiparous PAS with spontaneous uterine rupture and massive haemorrhage which necessitated emergency caesarean hysterectomy. 1-3 The conservative management of PAS leaving placenta in situ have been rarely reported in primiparous women. To the best of Authors’ knowledge, this is the third case in which PAS was conservatively managed with uterine conservation. 4,5 We reported a case of placenta accreta in a primigravida woman with fundal placentation with no identifiable risk factors for PAS. It was diagnosed incidentally during CD and managed conservatively leaving whole placenta in situ. Emergency caesarean hysterectomy for unsuspected DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20221301 1 Department of Obstetrics and Gynecology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India 2 Department of Obstetrics and Gynecology, AIIMS, Rishikesh, Uttarakhand, India Received: 08 March 2022 Accepted: 29 March 2022 *Correspondence: Dr. Amrita Gaurav, E-mail: aamrity@gmail.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. ABSTRACT Placenta accrete spectrum (PAS) disorder is rarely reported in primigravida woman without recognisable risk factors. It can be encountered intraoperatively without prior suspicion. Massive obstetric haemorrhage and increased maternal morbidity and mortality is often associated with emergency caesarean hysterectomy. We presented a 26-year-old primigravida who was presented to our institute as post-dated pregnancy in labour with no other comorbidities. She was taken up for cesarean section in view of prolonged labor. After birth of the baby, the placenta failed to separate on its own and could not be delivered with gentle controlled cord traction and uterine massage. Placenta was seen bulging out at left cornuo-fundal site as boggy mass in serosa of uterus as bluish distended placental bulge suggestive of placenta accreta. Placenta was left in situ and postoperatively uterine artery embolisation was done. Post-operatively patient did not develop any complications and follow up period of 6 months was uneventful. Conservative management of PAS can be judiciously contemplated in primiparous women desirous of fertility preservation and uterus conservation. The woman needs to be emphasised upon need for close follow up and risk of haemorrhage and sepsis till complete resorption of placenta occurs. Keywords: Placenta accreta spectrum, Primigravida, Conservative management