A team of obstetric specialists at ShardaCare-Healthcity has successfully managed an exceptionally rare pregnancy-related emergency, saving the life of a 36-year-old woman who developed severe postpartum haemorrhage after childbirth due to the coexistence of Placenta Accreta Spectrum (PAS) and a unicornuate uterus, a congenital uterine anomaly reported only rarely in medical literature.

The case highlights the importance of recognising recurrent retained placenta as a potential warning sign of an underlying uterine abnormality or abnormal placental attachment. According to global maternal health experts, postpartum haemorrhage remains one of the leading causes of maternal mortality worldwide, while Placenta Accreta Spectrum is increasingly being diagnosed due to rising Caesarean section rates. However, its occurrence in a unicornuate uterus remains exceptionally uncommon.

Specialists say the successful outcome underscores how early referral, multidisciplinary expertise and timely surgical intervention can make the difference between life and death in complex obstetric emergencies.

A History Of Repeated Pregnancy Complications

According to doctors at ShardaCare-Healthcity, the patient had experienced repeated obstetric complications over several pregnancies. She had previously delivered three premature babies between six-and-a-half and seven-and-a-half months of gestation. In each pregnancy, the placenta failed to separate naturally after delivery and required manual removal. Despite these recurring episodes, the underlying structural abnormality of her uterus had not been identified.

During her fourth pregnancy, she delivered another premature infant weighing approximately 1.7 kg at another hospital. However, the placenta again remained firmly attached despite repeated attempts to remove it. Nearly ten hours after delivery, she was referred to ShardaCare-Healthcity in an emergency.

What Doctors Found During Emergency Surgery

The patient was immediately taken to the operating theatre under the care of Dr Ruchi Shrivastava, Director, Obstetrics & Gynaecology. During surgery, doctors diagnosed Placenta Accreta Spectrum (PAS), a condition in which the placenta becomes abnormally attached to or invades the uterine wall, preventing its normal separation after childbirth.

According to the American College of Obstetricians and Gynecologists (ACOG), PAS is associated with severe obstetric haemorrhage and frequently requires blood transfusion and hysterectomy. It is considered one of the most serious pregnancy complications because delayed treatment can rapidly become life-threatening.

Further examination revealed an even rarer finding, a unicornuate uterus, a congenital anomaly where only one half of the uterus develops normally during fetal development. The coexistence of PAS with a unicornuate uterus has been documented only in isolated case reports, making the condition exceptionally uncommon.

Massive Bleeding Required Emergency Hysterectomy

As surgeons attempted to remove the placenta, the patient developed massive postpartum haemorrhage, one of the leading causes of maternal deaths globally. The World Health Organization (WHO) estimates that severe bleeding after childbirth accounts for approximately 27% of maternal deaths worldwide, particularly where timely specialist care is unavailable.

Recognising the rapidly deteriorating situation, the medical team performed an emergency hysterectomy to stop the bleeding and stabilise the patient. Both the mother and her premature newborn recovered successfully following treatment.

Speaking about the case, Dr Ruchi Shrivastava, Director, Obstetrics & Gynaecology at ShardaCare-Healthcity, said: "This was one of the most challenging obstetric emergencies we have managed because of the patient's repeated history of retained placenta and the rare uterine abnormality. Early recognition, prompt surgical intervention and seamless teamwork were crucial in saving the mother's life while ensuring the best possible outcome for the baby. Women with recurrent retained placenta or other high-risk pregnancy complications should undergo detailed evaluation and receive care at centres equipped to manage complex obstetric emergencies."

What Is Placenta Accreta Spectrum?

Placenta Accreta Spectrum refers to a group of conditions in which the placenta grows too deeply into the uterine wall instead of remaining attached only to its surface.

Depending on the depth of invasion, PAS is classified into:

  • Placenta accreta - attached too deeply
  • Placenta increta - invades the uterine muscle
  • Placenta percreta - penetrates through the uterine wall and may involve nearby organs

According to ACOG and the International Federation of Gynecology and Obstetrics (FIGO), risk factors include:

  • Previous Caesarean delivery
  • Placenta previa
  • Prior uterine surgery
  • Advanced maternal age
  • Previous uterine curettage

Management usually requires delivery in specialised centres with multidisciplinary teams capable of handling severe obstetric bleeding.

What Is A Unicornuate Uterus?

A unicornuate uterus is a rare congenital Mullerian duct anomaly in which only one side of the uterus develops fully. The European Society of Human Reproduction and Embryology (ESHRE) estimates that congenital uterine anomalies occur in around 5-7% of women, while a unicornuate uterus represents only a small fraction of these abnormalities.

Women with this condition may experience:

  • Infertility
  • Recurrent miscarriage
  • Preterm birth
  • Abnormal fetal position
  • Retained placenta
  • Pregnancy complications

Because symptoms may remain unnoticed until pregnancy, diagnosis often requires specialised imaging such as three-dimensional ultrasound or MRI.

Repeated Retained Placenta Should Not Be Ignored

Experts say one of the most important lessons from this case is the need to investigate women who repeatedly experience retained placenta after childbirth. According to the Royal College of Obstetricians and Gynaecologists (RCOG), retained placenta increases the risk of severe postpartum haemorrhage and should prompt careful evaluation for underlying placental abnormalities or uterine anomalies. Early referral to tertiary care hospitals with experienced obstetric surgeons, anaesthetists, blood bank support and neonatal intensive care facilities significantly improves maternal outcomes.

Commenting on the successful management, Dr Kousar Shah, Group CEO, ShardaCare-Healthcity, said: "Successfully managing such a rare and complex obstetric emergency reflects the advanced clinical expertise and multidisciplinary capabilities available at ShardaCare-Healthcity. Our commitment is to provide comprehensive care for even the most challenging high-risk pregnancies while ensuring the highest standards of patient safety."

Although the coexistence of Placenta Accreta Spectrum and a unicornuate uterus is exceptionally rare, this case serves as a reminder that recurrent retained placenta should never be dismissed as a routine obstetric complication. Early diagnosis, multidisciplinary planning and rapid access to specialised maternal healthcare can be lifesaving. As maternal health experts continue to stress, identifying high-risk pregnancies before complications arise remains one of the most effective ways to reduce preventable maternal illness and death.



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