Cesarean delivery is must in which of the following types of placenta pre
**Core Concept**
Placenta previa is a condition characterized by the implantation of the placenta over or near the internal cervical os, posing a risk of severe vaginal bleeding during pregnancy and delivery. The management of placenta previa depends on the location and severity of the placental implantation.
**Why the Correct Answer is Right**
In placenta accreta spectrum disorders (PASD), including placenta accreta, increta, and percreta, the placenta invades the uterine myometrium, making it difficult or impossible to separate the placenta from the uterus during delivery. In these cases, a cesarean delivery is usually performed under general anesthesia, often with a multidisciplinary team, to minimize the risk of severe bleeding. The placenta is left in place, and the uterus is usually left to involute with the placenta still attached. This approach minimizes the risk of severe bleeding and the need for a hysterectomy.
**Why Each Wrong Option is Incorrect**
**Option A:** - Placenta previa with a low-lying placenta may not require a cesarean delivery if the placenta is not covering the internal cervical os and the patient is stable.
**Option B:** - Placenta marginalis is a condition where the placenta is located at the margin of the internal cervical os. In most cases, a vaginal delivery can be attempted after careful evaluation and management.
**Option C:** - Placenta membranacea is a rare condition where the placenta covers a large area of the uterus but does not invade the myometrium. In these cases, a vaginal delivery may be possible after careful evaluation and management.
**Clinical Pearl / High-Yield Fact**
Placenta accreta spectrum disorders are increasing in incidence due to the rise in cesarean deliveries, and they are associated with significant maternal and fetal morbidity and mortality.
**Correct Answer:** C.