Gravid Hysterectomy in the Setting of Placenta Increta at 12 Weeks Gestation.

INTRODUCTION

Placenta accreta spectrum is characterized by placental adherence via abnormal trophoblast invasion into uterine myometrium and is associated with significant maternal morbidity and mortality. Given the legal changes to abortion care, discussion of pregnancy termination in the setting of placenta accreta spectrum disorders is worthy of discussion.

CASE PRESENTATION: We report the case of a 34-year-old gravida 6 para 2215 who was diagnosed with placenta previa with features consistent with accreta spectrum disease on ultrasound in the late first trimester. Following diagnosis, the patient was counseled on management options and ultimately underwent gravid hysterectomy for definitive treatment in the late first trimester.

DISCUSSION: This case was consistent with placenta accreta spectrum diagnosed in the late first trimester on ultrasound. Following early diagnosis and counseling, definitive management with gravid hysterectomy was undertaken. Pathologic evaluation confirmed placenta increta. Ability to perform gravid hysterectomy was done under the exception to Wisconsin's 1849 ban on termination of pregnancy for necessary termination in the setting of threat to maternal life.

CONCLUSIONS

Gestations affected by placenta accreta spectrum result in significant increased risk of maternal morbidity and mortality. Clinicians should be aware of the benefits of early diagnosis and patients counseled on options for definitive management, including termination if desired.