Placenta Previa Increta in an Unscarred Uterus with Marked Thinning of Myometrium in the Entire Uterus in a Patient with Systemic Lupus Erythematosus

A 36-yr-old woman, G5P2, who had a background history of systemic lupus erythematosus (SLE) was found to have placenta previa and placenta accreta on second trimester ultrasound scan. She had previous 3 spontaneous miscarriages but there was no history of gynecologic interventions. Apart from SLE, there was no other explanation for her recurrent miscarriage. The patient had ongoing thrombocytopenia in this pregnancy. The patient was taken for elective lower uterine segment cesarean section at 36 wk+5 d gestation. Balloon catheters were placed in the anterior branches of the internal iliac arteries before the operation. Despite this and aggressive medical management, she experienced significant bleeding requiring peripartum hysterectomy. Histologic examination showed placenta increta with marked thinning of the myometrium. The myometrium was <1 mm thick in most of the uterus except for lower uterine segment without any evidence of uterine rupture or perforation. This paper presents this unusual case of diffuse marked thinning of myometrium in the uterus as well as presence of placenta previa increta, without any prior history of gynecologic intervention in a patient with SLE.