First trimester placenta accreta is a rare occurrence but potential life threatening and catastrophic. Most of these
cases ended up with emergency hysterectomy. We report a case of incidental finding of placental accreta during
evacuation of retained product of conception (ERPOC) for missed miscarriage. A 33-year-old, Gravida 4 Para 2 + 1
at 15 weeks’ gestation admitted for missed miscarriage, failed medical evacuation requiring ERPOC. There was
excessive bleeding during the procedure and required hysterectomy and bilateral internal iliac artery ligation.
Histopathological examination confirmed products of conception with evidence of placenta accreta. This case
highlighted the diagnostic dilemma and importance of early accurate diagnosis of placental accreta prior to any
surgical intervention for miscarriage.