"Hemorragia obstétrica secundaria a placenta previa complicada con acretismo placentario"

Abstract

Background: Placenta previa states a placental implantation in the lower uterine segment, being very close or with some degree of coverage of the internal cervical os. Placental accreta refers to that placenta that has an adhesion disorder or some degree of invasion to either the uterus or adjacent structures. Abnormalities of placental insertion and fetal blood vessels are associated with vaginal bleeding in the second half of pregnancy. It is estimated that the incidence of placenta previa is 1 per 200 pregnancies with variations throughout the world; for placental accreta 1 for every 533 pregnancies. The rates of placenta previa and accreta are increasing, probably as a result of increased cesarean deliveries, maternal age and assisted reproductive technology. Clinical case: This is a 37-year-old woman with prenatal diagnosis of placenta previa by obstetric ultrasound, Doppler flowmetry, which shows no signs of acretism. However, in the transsurgical stage of cesarean delivery, signs of an aabnormal insertion are identified that later is determined as acretism. Conclusions: The present case is of interest for the management performed in addition to the unusual presentation of this pathology in a patient who did not present predisposing risk factors. The clinical characteristics, evolution and flowchart of diagnostic and therapeutic behavior in this case of a patient presenting placenta previa and the pathological insertion known as acretism have been determined. A brief updated bibliographical review with local relevance is included