Antenatal Care - Placenta Accreta

Question 1

What is Placenta Accreta?

Answer 1

The placenta implants deeper, through and past the endometrium, making it difficult to separate the placenta after delivery of the baby.

Question 2

Physiology of Placenta.

Answer 2

The placenta usually attaches to the endometrium so that it can separate cleanly during the 3rd Stage of Labour.
Pathophysiology : Defective Decidua Basalis.

Question 3

Risk Factors of Placenta Accreta (6).

Answer 3

1. Previous Placenta Accreta.
2. Previous Endometrial Curettage Procedures.
3. Previous C-Section.
4. Multigravidity.
5. Increased Maternal Age.
6. Low-Lying Placenta or Placenta Praevia.

Question 4

Placenta Accreta Spectrum (3).

Answer 4

1. Superficial Placenta Accreta - Placenta implants into surface of Myometrium but not beyond.
2. Placenta Increta - Placenta attaches deeply into the myometrium.
3. Placenta Percreta - Placenta invades past the myometrium and perimetric, potentially reaches other organs e.g. bladder.

Question 5

Clinical Presentation of Placenta Accreta (2).

Answer 5

1. Antepartum Haemorrhage in 3rd Trimester.
2. Cause of Significant Postpartum Haemorrhage.

Question 6

`Diagnosis of Placenta Accreta (2).

Answer 6

1. Antenatal US Scans.
2. At Birth - Clinically (difficult to deliver Placenta).

Question 7

Management of Diagnosed Placenta Accreta (3).

Answer 7

1. MRI to assess depth and width of invasion.
2. Specialist MDT.
3. Planned C-Section between 36-37 Weeks.

Question 8

Surgical Options of Placenta Accreta during C-Section (3).

Answer 8

1. Hysterectomy : Placenta remains in uterus (recommended).
2. Uterus-Preserving Surgery (Resection of Part of the Myometrium with Placenta).
3. Expectant - Leave Placenta to be resorbed (risk : infection, bleeding).