Placenta Accreta Spectrum in the Intrauterine Fetal Death: An Evidence-Based Case Report

Abstract

Introduction: Placenta Accreta Spectrum (PAS) is a life-threatening obstetric disorder characterized by abnormal placental invasion into the myometrium. Although intrauterine fetal death (IUFD) and PAS are distinct conditions, their
coexistence substantially increases maternal morbidity and presents major management challenges.
Case Presentation: A 33-year-old gravida 3 para 1 woman at 21–22 weeks of gestation with a history of cesarean section and curettage presented with IUFD. Following vaginal misoprostol induction, she developed massive hemorrhage, hemodynamic instability, and hemorrhagic shock, requiring emergency hysterectomy. Histopathological examination confirmed placenta accreta.
Methods: An evidence-based case report was conducted using a structured literature search of PubMed, ScienceDirect, Springer, and the Cochrane Library. Eligible studies included systematic reviews, cohort studies, and original research evaluating the relationship between PAS and IUFD.
Results: Of 578 identified articles, four met the inclusion criteria. Evidence consistently demonstrated that PAS is associated with increased maternal morbidity in IUFD pregnancies, particularly among women with previous cesarean delivery. Severe hemorrhage frequently necessitated hysterectomy.
Conclusion: This case highlights the importance of early antenatal recognition of PAS in women with IUFD and previous uterine surgery. Prompt multidisciplinary management and preparedness for massive obstetric hemorrhage are essential to reduce maternal morbidity and mortality.