PLACENTA ACCRETA SPECTRUM IN AN UNSCARRED UTERUS: A RARE AND UNEXPECTED OBSTETRIC EMERGENCY

Placenta accreta spectrum (PAS) represents abnormal trophoblastic invasion into the myometrium and is a major cause of obstetric hemorrhage and maternal morbidity. It is most commonly associated with prior uterine surgery and placenta previa. Occurrence in a primigravida with an unscarred uterus and no identifiable risk factors is rare and frequently unsuspected. We report a case of a 24-year-old unregistered primigravida at 38 weeks of gestation who presented with severe preeclampsia and acute fetal distress necessitating emergency cesarean delivery. Intraoperatively, the placenta failed to separate, raising suspicion of PAS. Given minimal hemorrhage and hemodynamic stability, conservative management with the placenta left in situ was undertaken. Postoperative imaging suggested placenta increta/percreta. A single dose of methotrexate was administered, followed by spontaneous vaginal expulsion of the placenta on postoperative day three. The patient remained clinically stable, avoided hysterectomy, and fertility was preserved. This case highlights the importance of intraoperative vigilance and individualized management in unexpected PAS.