Conservative Management of Placenta Accreta Spectrum Associated with Placenta Previa in a Primigravid Woman: A Case Report

Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric disorder characterized by abnormal placental invasion into the uterine wall and is strongly associated with placenta previa and previous cesarean delivery (۱,۲). However, its occurrence in primigravid women without prior uterine surgery is uncommon. We report the case of a ۲۲-year-old primigravid woman at ۳۸ weeks and ۶ days of gestation who was referred with placenta previa and suspected placenta accreta. The patient presented with mild abdominal pain without vaginal bleeding or spotting during pregnancy. Ultrasonography and Doppler imaging confirmed placenta accreta previa with a cephalic fetus and amniotic fluid index of ۵۰ mm. Following multidisciplinary preparation, including blood product reservation and continuous fetal monitoring, cesarean section was performed using a classical uterine incision. Intraoperative bleeding was controlled with oxytocin and supportive management. Complete placental removal was achieved successfully without hysterectomy. A healthy male neonate weighing ۳۲۰۰ g with Apgar scores of ۹/۱۰ was delivered. Postoperative hemoglobin levels remained stable, and both mother and neonate were discharged in good condition after ۴۸ hours. This case highlights the importance of early antenatal diagnosis and demonstrates that conservative management without hysterectomy may be feasible in selected PAS patients.

کلیدواژه ها:

Placenta accreta spectrum ، Placenta previa ، Primigravida ، Conservative management