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Scalloping of placenta–myometrium interface on ultrasound in case with myomectomy scar

A 41-year-old primigravid woman presented at 16 weeks’ gestation for antenatal care. Two years previously, she had undergone laparoscopic enucleation of 12 myomas during which the uterine cavity was not entered. Ultrasound examination at 20 weeks showed an anterior placenta that was not low-lying, and an irregular placenta–myometrium interface with focal myometrial thinning, suspicious of placenta accreta (Figure 1a and b). She failed to attend follow-up examinations until 36 weeks, when ultrasound showed scalloping of the placenta and persistence of focal myometrial thinning, again suggesting placenta accreta (Figure 1c–e). Typical sonographic features of myometrial invasion described in cases with Cesarean scar and placenta previa, such as placental lacunae or subplacental hypervascularity, were absent. A plan for Cesarean delivery and uterine conservation should accreta be encountered intraoperatively was made at the patient’s request. Elective lower-segment Cesarean section was performed at 38 weeks, and the neonate was delivered in good condition. Despite monitoring for 3 h, less than 10 g of placenta separated from the uterine wall spontaneously. Bilateral uterine artery embolization was performed. Total blood loss was 1.2 L. On ultrasound examination, the retained placenta measured 13 × 12 × 8 cm (Figure 2a and b). Postoperative recovery