A 37-year-old woman, gravida 4, para 3, at 35 weeks' gestation is admitted to the hospital in active labor. She has had no prenatal care. Two years ago, she delivered her 3rd child by uncomplicated cesarean delivery. The patient appears in acute distress. Her pulse is 98/min, respirations are 15/min, and blood pressure is 130/80 mm Hg. The abdomen is nontender and contractions are felt. One hour following vaginal delivery, the placenta is not delivered. Manual separation of the placenta leads to profuse vaginal bleeding. A firm, nontender uterine fundus is palpated at the level of the umbilicus. Which of the following is the most likely cause of this patient's ongoing vaginal bleeding?

Question

Quizplus · Accepted Answer

Eductional Objective: Placenta accreta spectrum occurs due to placental invasion into the myometrium through defects in the decidua basalis.  This creates a morbidly adherent placenta that does not detach after fetal delivery, leading to postpartum hemorrhage.  Manual placental extraction typically yields small placental fragments and increases bleeding.

A 37-Year-Old Woman, Gravida 4, Para 3, at 35 Weeks