Revisão narrativa: complicações graves devida acretismo placentário em útero sem cicatriz

Despite its rarity, placenta accreta spectrum in unscarred uteri remains a significant diagnostic blind spot in obstetric care, often revealed only after catastrophic clinical deterioration. This narrative review analyzes case studies to elucidate clinical challenges and propose a paradigm shift in the diagnostic approach. Clinical manifestations are dangerously variable, presenting as an acute surgical abdomen—often misdiagnosed as appendicitis or hepatic rupture—or as massive, refractory postpartum hemorrhage, frequently following attempts at removal of a retained placenta. Diagnosis is most often incidental, in contrast to the potential for prenatal suspicion through ultrasonography, even in patients considered to be at low risk. Emergency cesarean hysterectomy remains the main surgical damage-control strategy, resulting in loss of fertility. Maternal outcomes are marked by the need for massive transfusion, while fetal outcomes are associated with prematurity. It is concluded that a high level of diagnostic vigilance and individualized management in tertiary care centers are imperative to optimize outcomes in this frequently concealed obstetric emergency.