**Question:** Which of the following findings are highly predictive of placenta accreta?

**Core Concept:** Placenta accreta is a complication of pregnancy characterized by abnormal implantation of the placenta, where it penetrates through the myometrium and into the uterine serosa, leading to increased risk of life-threatening hemorrhage and maternal morbidity.

**Why the Correct Answer is Right:** The correct answer, "D," refers to the presence of a "bloodless hysterectomy" in the surgical history. A bloodless hysterectomy indicates that the uterus was previously resected without significant blood loss, which is a risk factor for placenta accreta due to previous caesarean section (CS) scarring and weakened myometrium.

**Why Each Wrong Option is Incorrect:**
A. **Option A (history of previous uterine surgery)**: This is not specific enough. While uterine surgery increases the risk of placenta accreta, a history of only uterine surgery does not necessarily indicate a bloodless hysterectomy.
B. **Option B (history of previous cesarean section)**: This is also not specific enough. A history of previous cesarean section increases the risk of placenta accreta, but a bloodless hysterectomy is the more specific predictor.
C. **Option C (history of previous uterine infection)**: This option is unrelated to the risk factors for placenta accreta, which are mainly surgical interventions.

**Clinical Pearl:** The correct answer, "D," highlights the importance of considering surgical history in assessing a patient's risk for placenta accreta, particularly a bloodless hysterectomy, which is indicative of previous uterine surgery weakening the uterine wall. This knowledge is crucial for healthcare professionals to anticipate and prepare for potential life-threatening hemorrhage and uterine rupture in these patients.

**Correct Answer:** D. history of a bloodless hysterectomy

✓ Correct Answer: C. Less than 1 mm between uterine serosa - bladder interface and retroplacental vessels ; large placental lakes.