37-year-old Gravida 5 with anterior placenta previa at 21 weeks and five prior cesarean deliveries is at greatest risk for which condition?

37-year-old Gravida 5 with anterior placenta previa at 21 weeks and five prior cesarean deliveries is at greatest risk for which condition?

• A. Placenta accreta
• B. Placenta previa
• C. Placental abruption
• D. Vasa previa

Answer: (A)

Placenta accreta is most likely here because placenta previa combined with extensive uterine scarring from multiple prior cesarean deliveries markedly increases abnormal placental invasion into the myometrium. Scar tissue at the site of prior cesareans disrupts normal decidua basalis, so placental villi can attach directly to, or invade, the myometrium (accreta, increta, or percreta). An anterior placenta over a scarred fundus further raises this risk, and it has major implications at delivery, including severe postpartum hemorrhage and the potential need for cesarean hysterectomy. While placenta previa is already present, and placental abruption or vasa previa have their own risk factors, the combination of previa with extensive uterine scarring makes placenta accreta the most likely additional complication in this scenario.

Placenta accreta is most likely here because placenta previa combined with extensive uterine scarring from multiple prior cesarean deliveries markedly increases abnormal placental invasion into the myometrium. Scar tissue at the site of prior cesareans disrupts normal decidua basalis, so placental villi can attach directly to, or invade, the myometrium (accreta, increta, or percreta). An anterior placenta over a scarred fundus further raises this risk, and it has major implications at delivery, including severe postpartum hemorrhage and the potential need for cesarean hysterectomy.

While placenta previa is already present, and placental abruption or vasa previa have their own risk factors, the combination of previa with extensive uterine scarring makes placenta accreta the most likely additional complication in this scenario.