Placenta previa and accreta complicated by amniotic fluid embolism.

Background: The simultaneous occurrence of placenta previa and placenta accreta in patients who had previous low transverse cesarean delivery is presently well established. However, the sequence of previous cesarean delivery followed by placenta previa and accreta in a patient who also experiences a premature rupture of membranes as well as amniotic fluid embolism (AFE) is a rare obstetric phenomenon.

Case: A 24-year-old woman, para 2 with two previous cesarean deliveries, at 32 weeks' gestation by last menstrual period, was admitted with premature rupture of membranes. A repeat cesarean delivery (CD) was done. Excessive hemorrhage occurred, necessitating a hysterectomy. Also, the patient developed an amniotic fluid embolism.

Conclusion: Placenta previa and placenta accreta may be observed in patients who have a previous CD scar and in whom AFE develops suddenly and unexpectedly. AFE, a condition with complex pathogenesis, presents a number of challenges, with the patient undergoing serious complications that may include massive hemorrhage, disseminated intravascular coagulopathy, and death. The obstetrician should be alert to the symptoms of AFE, and if they occur should begin prompt and aggressive treatment.