Uncommon type of placentation after previous cesarean deliveries

BACKGROUND: A rare type of placentation leading to cesarean delivery and hysterectomy is described. CASE: A young multigravida in the 26th week of gestation was referred to our department with a history of vaginal bleeding and suspected placenta previa. Three previous children were delivered by elective cesarean. Ultrasonographic examination suggested placenta previa increta with hypervascularization and with pulsatile lacunar flow. In the 38th week of gestation, an elective cesarean delivery and hysterectomy were performed. Morphological studies showed that most of the placenta developed in the anterior portion of the cervix. The implantation took place in the scar tissue, promoting infiltration of the increted growth and thus ensuring the normal development of the amnionic sac and fetus in the uterine cavity. CONCLUSION: Variations in placental implantation may result in unique situations at birth. (C) 2003 by The American College of Obstetricians and Gynecologists.