Lack of Antenatal Care Resulting in Intraoperative Diagnostic Challenges of Dense Adhesions Imitating Placenta Accreta Spectrum: A Case Report

Background: Adhesions are a common long-term complication following surgery and can complicate surgical access. In some cases, intraoperative adhesion findings may resemble the placenta accreta spectrum (PAS), leading to diagnostic confusion and unnecessary referral to tertiary care centers. This case highlights a misdiagnosis of suspected PAS, which was ultimately identified as intraoperative adhesions. Case Illustration: A 30-year-old woman, G2P1 (2nd pregnancy), at full-term gestation, was referred from a district hospital with a prior history of cesarean section 12 years ago. The patient was admitted to the hospital one day prior to surgery. She presented with the latent phase of labor with increasing contractions that had begun the day before. Cesarean delivery was scheduled for the following day. During laparotomy, dense adhesions were encountered, raising suspicion of placenta accreta spectrum and prompting referral to a tertiary care facility. At the referral hospital, an emergency cesarean section was performed due to uterine inertia in a previously scarred uterus. Upon entering the peritoneal cavity, adhesions were observed between the left lateral aspect of the uterus and the left adnexa and between the bladder and the lower uterine segment. The adhesions were classified as Grade I–II. Adhesiolysis was carried out using a combination of sharp and blunt dissection. Further intraoperative founding no evidence of bridging vessels, abnormal vascularization, or uterine bulging suggestive of placenta accreta spectrum. A female neonate weighing 2890 grams was delivered via cesarean section, and the placenta was entirely expelled with gentle traction on the umbilical cord. Conclusion: Preoperative diagnosis of adhesions remains challenging. Adequate preoperative examination such as ultrasonography examination are essential in managing pregnancy with prior caesarean section. Keywords: adhesions, cesarean section scar, diagnosis, placenta accreta spectrum