Differential Diagnosis
- Single most likely diagnosis
- Placenta accreta spectrum (PAS) disorder: The presence of a low-lying placenta with numerous lacunae and myometrial thinning on ultrasound is highly suggestive of placenta accreta spectrum disorder, especially given the patient's history of prior uterine surgeries (dilation and curettage procedures).
- Other Likely diagnoses
- Placenta previa: Although the placenta is described as low-lying, the presence of numerous lacunae and myometrial thinning may also be seen in placenta previa, and the patient's symptoms and ultrasound findings could be consistent with this diagnosis.
- Uterine scar dehiscence or rupture: Given the patient's history of prior uterine surgeries, there is an increased risk of uterine scar dehiscence or rupture, especially if the placenta is implanted over the scar.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Placental abruption: Although the patient is asymptomatic, placental abruption can occur suddenly and without warning, and it is essential to consider this diagnosis in any pregnant patient with a history of prior uterine surgeries or placental abnormalities.
- Uterine artery pseudoaneurysm: This is a rare but potentially life-threatening condition that can occur in patients with a history of uterine surgery or placental abnormalities.
- Rare diagnoses
- Vasa previa: This is a rare condition where fetal blood vessels are present in the membranes covering the cervix, and it can be associated with placental abnormalities and prior uterine surgeries.
- Choriocarcinoma: This is a rare malignant tumor that can occur in the uterus during pregnancy, and it may be associated with placental abnormalities and prior uterine surgeries.