BACKGROUND:

Placental accreta occurs when part or all of the placenta invades and is inseparable from the uterine wall, associated with procedures that entail scarring in the uterus.

OBJECTIVE:

To review three cases in primiparous patients without a history of previous uterine procedures who presented placental accreta, in addition to evaluating the inclusion of new risk factors that may influence the presence of the pathology.

CLINICAL CASES:

Case 1: 22-year-old primigravity, ultrasound at 35.3 weeks, with total placenta previa and 2/6 ultrasound signs of placenta accreta. During cesarean section, increased vascularity is identified, predominantly in the segment requiring obstetric hysterectomy. Histopathological reported was placenta increta. Case 2: 39-year-old primigravity, prenatal ultrasound report normal inserted placenta. A cesarean section was performed for suspected premature detachment of a normoinserted placenta. Trans-surgical placenta attached to the uterine fundus and right cornual region was observed, requiring obstetric hysterectomy. Histopathological report was placenta increta. Case 3: 28-year-old primigravity. Obstetric ultrasound, fundic placenta grade II. In the surgical act, a highly vascularized uterus was reported, upon delivery, a placenta was observed invading myometrium and serosa, requiring obstetric hysterectomy. Histopathological report was placenta accreta.

CONCLUSION:

The diagnosis of placental accreta is usually suspected in patients who have undergone previous uterine procedures for obstetric, gynecological or other causes. However, all patients should be screened regardless of the medical-surgical history in order to reduce maternal morbidity and mortality, in addition to proposing lines of action and prevention alternatives to provide a timely and multidisciplinary comprehensive management.

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