Importance of Regular Prenatal Care: A Placenta Percreta: Sudden Death Case Report

Abstract

History of Present Illness: A 42-year-old Black female was diagnosed with placenta percreta at one of her routine prenatal visits. She had recently been seen by her high risk obstetrician for this complication and had no complaints. However, she stopped attending regular doctor’s appointments due to COVID-19 concerns. At 28 weeks gestation, she experienced nausea and vomiting which she attributed to a “stomach bug.” The following morning, she was found unconscious in the bathroom and pronounced dead at the scene with no evidence of fetal activity. Pertinent history: Two previous spontaneous abortions at 8 weeks gestation. Autopsy findings:

3 liters of hemoperitoneum due to uterine rupture due to placenta percreta Extensive infiltration of the chorionic villi into myometrium, bladder, and surrounding pelvic soft tissue, resulting in inability to separate placenta from uterus Complete placenta previa Gravid uterus consistent with 28 week gestation; Normally developed female fetus

Cause of Death: Hemoperitoneum due to uterine rupture due to placenta percreta Management

Screening for PAS disorder during prenatal visits is crucial for the planning of safe pregnancy and delivery. Prenatal visits allow for patients with PP to be educated about symptoms that should prompt them to seek urgent medical attention. Surgical and conservative measures are available as treatment options for PAS disorders, depending on the clinical situations.

What is Placenta Percreta (PP)?

A placenta accreta spectrum (PAS) disorder Chorionic villi of the placenta invade through the uterine wall or into the surrounding organs such as the bladder. Most PAS disorders are asymptomatic, but can cause hematuria, vaginal bleeding, and abdominal pain. Risk factors include previous uterine surgical procedures, placenta previa, in vitro fertilization, high maternal age, endometriosis, smoking, etc.

Clinical Significance:

Complications include hemorrhage, preterm birth, or even uterine rupture with a maternal mortality rate of 5.6%. Patients with undiagnosed PAS have a higher rate of delivery complications due to attempted placental separation.

Diagnosis:

Prenatal diagnosis is usually made by ultrasound examination. Features such as placental lacunae, disruption of the bladder line, and ballooning of myometrium into the bladder suggest PAS. Magnetic resonance imaging (MRI) facilitates the diagnosis in uncertain cases.

Discussion: COVID-19 Impact: The pandemic discouraged patients from routine prenatal visits, The lack of regular prenatal care may lead to worse clinical outcome related to the PAS disorders. Conclusion: Placenta percreta is a rare, but potentially fatal complication of pregnancy. Prenatal screening and routine office visits are crucial in the diagnosis and management.