Considerations

This patient has two previous uterine incisions, which increases the risk of placenta accreta. The placenta is noted to be very adherent to the uterus, which is the clinical definition of placenta accreta, although the histologic diagnosis requires a defect of the decidua basalis layer. The usual management of taie placental accreta is hysterectomy because attempts to remove a firmly attached placenta often lead to hemorrhage and/or maternal death. Conservative management of placenta accreta, such as removal of as much placenta as possible and packing the uterus, often leads to excess mortality compared to immediate hysterectomy.

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