8.22 Placenta Accreta Flashcards
What is placenta accreta?
when the placenta implants deeper and past the endometrium (into myometrium).
makes it harder to deliver the placenta
its a spectrum
varies in depth and breadth of abnormal implantation area
What are the 3 further definitions of placenta accreta?
Superficial placenta accreta is where the placenta implants in the surface of the myometrium, but not beyond
Placenta increta is where the placenta attaches deeply into the myometrium
Placenta percreta is where the placenta invades past the myometrium and perimetrium, potentially reaching other organs such as the bladder
What is superficial placenta accreta?
placenta implants in the surface of the myometrium, but not beyond
What is placenta increta?
placenta attaches deeply into the myometrium
What is placenta percreta?
placenta invades past the myometrium and perimetrium, potentially reaching other organs such as the bladder
What are the risk factors for placenta accreta?
- Previous placenta accreta
- Previous endometrial curettage procedures (e.g. for miscarriage or abortion)
- Previous caesarean section
- Multigravida
- Increased maternal age
- Low-lying placenta or placenta praevia
How is placenta accreta diagnosed?
possibly antenatally on US in which case proceed to MRI to assess
at birth during 3rd stage (difficult to deliver placenta / PPH)
How is delivery planned for placenta accreta? Management options?
planned for 35 - 36+6 weeks
During c-section options:
- Hysterectomy with the placenta remaining in the uterus (recommended)
- Uterus preserving surgery, resection of part of the myometrium along with the placenta
- Expectant management, leaving the placenta in place to be reabsorbed over time (high infection risk)
What should you do if placenta accreta is discovered ELCS?
RCOG:
- during? then close abdo and delay delivery until specialist services available
- after delivery? hysterectomy is recommended
