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Placental Accreta

Placenta accreta is a serious pregnancy condition that occurs when the placenta grows too deeply
into the uterine wall. Typically, the placenta detaches from the uterine wall after childbirth. With placenta
accreta, part or the entire placenta remains attached. This is an usually deep attachment of the placenta to
the uterine myometrium so deeply the placenta will not loosen and deliver. If it attempts to remove it
manually may lead to extreme haemorrhage because of the deep attachment. Or it can cause severe blood
loss after delivery.

Cause

Placenta accreta is thought to be related to abnormalities in the lining of the uterus, typically due
to scarring after a C-section or other uterine surgery. Sometimes, however, placenta accreta occurs
without a history of uterine surgery.

Types of Placenta Accreta


Placenta accreta is the general term to describe this condition, but there are three specific types of this
condition:

 Placenta accreta. The placenta firmly attaches to the wall of the uterus, but does not pass
through the wall or impact the muscular wall of the uterus.
 Placenta increta. The placenta is more deeply embedded in the wall of the uterus and also firmly
attaches to the muscular wall of the uterus.
 Placenta percreta. The placenta extends through the wall of the uterus and muscles and, in some
cases, attaches to other nearby organs such as the bladder or intestines.

What Can Happen If You Have Placenta Accreta?

 The heavy vaginal bleeding associated with placenta accreta can prevent the blood from clotting
as it normally would, and can also lead to lung and kidney failure.
 Placenta accreta increases the risk of premature labor.
 If the condition causes you to start bleeding during your pregnancy, you might be required to
deliver your baby early via cesarean section.
 Extreme haemorrhage

Signs and Symptoms:

 Placenta accreta often causes no signs or symptoms during pregnancy — although vaginal
bleeding during the third trimester might occur.
 Occasionally, placenta accreta is detected during a routine ultrasound.
Risk Factors:
 Placenta previa with or without previous uterine surgery
 Previous myomectomy
 Previous caesarean delivery
 Asherman’s syndrome
 Submucus leiomyomata
 Maternal age of 36 years old and older
Management:
 Caesarean hysterectomy (all or part of the uterus is removed.)
 Uterine conservation
- Placental removal and over sewing uterine defect
- Localized resection and uterine repair
- Leaving the placenta in situ and treat with antibiotics and removing it later
 Consultation with a maternal-fetal medicine specialist is desirable, and transfer to a Center of
Excellence for placenta accreta is strongly advised
 Treatment with methotrexate to destroy the still attached tissue may be necessary.
 Your healthcare provider may offer or recommend an amniocentesis test. This test can help your
provider determine the best timing for the cesarean, as it can help assess whether your little one’s
lungs are mature enough for birth.

Reference:

Anomalies of Placenta and Cord page 648-649/ Volume1 6th Edition

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709317/

https://www.pampers.com/en-us/pregnancy/healthy-pregnancy/article/placenta-accreta