Placenta Increta Manifesting As Unusual Cervical Mass after First Trimester Dilatation and Curettage, Managed by Laparoscopy

Placenta accreta spectrum, is characterized by abnormal placental adherence to the myometrium. Depending on the depth of trophoblastic growth, it is classified into placenta accreta, placenta increta, and placenta percreta. This condition is associated with life-threatening hemorrhage, resulting in high maternal and neonatal morbidity and mortality. Placenta accreta usually presents with vaginal bleeding during difficult placental removal in the third trimester. Placenta accreta spectrum is very rarely present in the first trimester. Severe forms may complicate first-trimester pregnancy losses, causing profuse postcurettage hemorrhage. A 28-year-old lady with one living issue by cesarean section who had undergone a dilatation and curettage (D & C) 2 months ago for missed abortion, came with the complaints of prolonged vaginal bleeding following the procedure. On pelvic examination, the uterus was bulky, partly firm on one side, and soft on the other. Ultrasound examination revealed it to be a bicornuate uterus with retained products in one of the horns. Magnetic resonance imagining was suggestive of lateral cervical fibroid. Diagnostic laparoscopy revealed it to be a left lateral cervical mass. Total laparoscopic hysterectomy was performed. On histopathological examination, specimen revealed necrotic placenta infiltrating the endocervix and isthmus. Placenta accreta is a rare problem and difficult to diagnose in the first trimester. It can occur when there are risk factors or if there are ultrasound markers of the first trimester suspicious of the adherent placenta. A diagnosis of placenta accreta spectrum needs to be considered when there is post-D & C prolonged or heavy vaginal bleeding.