Fundal Hysterotomy in Central Placenta Previa with Signs of Placenta Accreta Spectrum

Abstract

Placenta previa associated with placenta accreta spectrum (PAS) is a high-risk obstetric condition associated with significant maternal and fetal morbidity and mortality. This study aims to report a case of complete placenta previa associated with placenta accreta spectrum managed at a tertiary referral hospital using a multidisciplinary approach. A 25-year-old woman with a history of a previous cesarean section was diagnosed during prenatal follow-up with progression from a low-lying placenta to complete placenta previa. Imaging studies demonstrated findings suggestive of placenta accreta spectrum. The patient was admitted at 37 weeks of gestation for a planned elective cesarean delivery. A fundal uterine incision (fundal hysterotomy) was performed to avoid placental disruption. During surgery, additional intervention was required because of left adnexal bleeding, leading to left salpingectomy and oophorectomy. The patient received blood transfusion and remained hemodynamically stable, with a favorable maternal outcome. This case highlights the importance of accurate prenatal diagnosis, meticulous surgical planning, and a multidisciplinary team approach in the management of placenta accreta spectrum, contributing to the reduction of complications and improved maternal outcomes.