Incedental Finding of Placenta Increta in a Patient with Vaginal Bleeding Refractory to Medical Treatment

Placenta increta can be a life threatening obstetrical complication. Although most commonly diagnosed in second and third trimester upon difficult placental removal and post partum bleeding, there have been several first trimester cases reported. These cases by and large present with vaginal bleeding and/ or hemorrhage. They can present both immediately after instrumental abortions or curettage, and weeks to months after spontaneous abortions. Part of the difficulty in diagnosing and treatment of this clinical scenario in the first trimester is its rarity. Approximately 1: 2500-7000 placental pathologies are accreta, increta and percreta in nature. These only represent reported cases, and since first trimester findings are the least common, it is unclear what percentage they import. The abnormality in the placenta [1] that leads to increta is the absence of the decidua basalis and imperfect development of the fibrinoid layer, also known as the Nitabuch Layer.