PMC9925233_01
(a)-(c) Transvaginal ultrasound findings. (a) Low implantation of the gestational sac and the placenta attached to the posterior wall of the uterus (dotted line) are observed at 7 weeks of gestation. The anterior myometrium including the cesarean scar is intact. (b) The cervical length is 14 mm at 13 weeks of gestation. (c) Placental insertion into the cervix and cervical shortening are noted at 20 weeks of gestation. (d) Magnetic resonance imaging findings at 30 weeks of gestation. Sagittal T2-weighted half Fourier single-shot turbo spin echo (HASTE) sequence images show the insertion of the placenta into the effacement of the cervical canal, intraplacental vasodilatation (white arrowheads), and heterogeneity within the placenta. (e) Surgical specimen of cesarean hysterectomy. A swollen lower uterine segment is noted. (f) and (g) Histopathological finding. (f) White arrowheads indicate the boundaries of the placenta and myometrium. The placenta extensively adhered to the anteroposterior wall from the lower uterine segment to the cervix. (g) The placenta invading the myometrium (dotted line) is observed. The scale bar indicates 500 mum. GS, gestational sac; Cx, cervix; Cor, corpus of the uterus; Pl, placenta; Fd, fundus; Mm, myometrium; Pm, perimetrium.
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PMC9925233_01_CRIOG2023-1816955.001.jpg
fig1
A transvaginal ultrasonographic examination revealed low implantation of the gestational sac (GS) with a heartbeat (Figure 1(a)). Thereafter, a small amount of genital bleeding was occasionally observed, and the placenta was gradually inserted into the cervix with cervical shortening (Figures 1(b), 1(c), and 2). Magnetic resonance imaging (MRI) at 30 weeks of gestation revealed insertion of the placenta into the effacement of the cervical canal, irregularity and thinning of the myometrium, loss of the signal at the placental muscle layer boundary, intraplacental vasodilatation, intraplacental hypointense areas, and heterogeneity within the placenta (Figure 1(d)), which strongly suggested placenta accreta. Upon gross inspection, the lower uterine segment was dilated due to the placenta, the cervix had effaced (Figure 1(e)), and the placenta was visible from the cervical os. A histopathological examination of the placenta and uterus revealed placenta previa with extensive adhesions into the anteroposterior wall, mainly into the posterior wall from the lower uterine segment to the cervix (Figures 1(f) and 1(g)).