Placenta Accreta Managed by Total Hysterectomy in Tanzania: A Case Report

Background: Placenta accreta spectrum is one of the most serious complications of placenta previa, which is associated with maternal and perinatal mortality and morbidity. The management of placenta accreta includes the gold standard, Total hysterectomy, but occasionally conservative management can also be done. The incidence of placenta accreta varies in different studies from 1 per 272, 9 per 1000, and 4.3 per 10,000. The increase in the incidence of placenta accreta is directly related to the increased rates of previous cesarean section scars. The incidence of placenta accreta will also increase due to a history of previa. A case of Mrs. W.J.K a34 years G8 P4 + 3 at a gestation age of 40 weeks, with a history of three previous scars comes with presenting complaints of per vaginal bleeding for the past four hours, diagnosis of placenta previa was made on a clinical basis and obstetrics ultrasound, the patient was prepared for caesarian section and a female baby scored 7 - 10 weighted 2.2 kg was delivered and found also was placenta accrete were by it was difficulty in repairing uterus due to excessive bleeding from the placenta niche and finally total hysterectomy was done. The patient recovered well in the ward and was discharged on 3/11/2024 in good condition. Discussion: Lower section caesarian section followed by a hysterectomy has been shown to reduce the risk of poor fetal and maternal outcomes. Prenatal screening of pregnant women with risks by doing first, second, and third-trimester obstetric ultrasound and Planned delivery at 34+ and 36 + 6 has been associated with a significant reduction in bad obstetric outcomes. Conclusions: Placenta accreta is becoming an increasingly common complication of pregnancy. The reason for the rate increase is the increase in rates of the caesarian sections. Prenatal diagnosis is a key factor in Planning for the counseling, treatment, and outcome of women with placenta accreta. Cesarean hysterectomy is the gold standard and probably the preferable treatment. Conservative management can only be used in highly selected cases.