Presentation
Noted on bedside transabdominal ultrasound scan: loss of myometrium at the lateral fundal area with small lacuna. To rule out placenta accreta.
Patient Data
Evidence of lower segment cesarean scar.
Gravid uterus with a singleton fetus in the cephalic lie.
The main bulk of the placenta lies in the right lateral region at the fundus of the uterus.
The placental edge is smooth with gradual tapering. No abnormal lump or contour bulge.
No obvious intraplacental dark band.
A minimal prominent flow void seen at the right posterior aspect of the placental bulk likely elevated vascularity at the myometrial-placental interface.
Urinary bladder is partially distended.
Case Discussion
G4P2+1 patient at 30 weeks period of amenorrhea. Two previous scars for the history of uterine rupture at the fundus and bleeding placenta previa respectively.
Elective classical cesarean section with bilateral salpingectomy was done at 32 weeks. The lower segment was thinned out. Deficient myometrium was noted at the fundal site measuring 2x2cm. No placenta accreta. Moderate adhesion of the anterior wall of the uterus with the omentum. Adhesiolysis done. Bilateral fallopian tubes and ovaries are normal.
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