Placenta accreta Flashcards
in basic terms, what is a placenta accreta?
placenta accreta is when the placenta invades beyond the level of the endometrium (i.e. into the myometrium or into the perimetrium)
what will predispose to a placenta accreta?
previous injury to the endometrium e.g. a previous caesarean or a previous placenta accreta
risk factors for a placenta accreta
previous PA
previous c-section
previous surgery on the uterus
increasing maternal age
increasing parity
low-lying placenta/placenta praevia
what is the main risk associated with a placenta accreta?
there is unlikely to be easy detachment of the placenta during labour and this will most likely lead to a PPH
superficial placenta accreta vs
placenta increta vs
placenta percreta
embedded into the surface of the myometrium but not beyond
embedded deeply within the myometrium
invades past the perimetrium, sometimes even into the bladder!
how does placenta accreta usually present?
t is usually asymptomatic but can cause antepartum heamorrhage
how is placenta accreta generally diagnosed?
USS
how can the depth of placenta accreta be assessed?
MRI
when is delivery planned for a placenta accreta?
generally it is planned for 35-36+6 weeks
during a caesarean section, what are the options for managing a placenta accreta? (3)
hysterectomy (this is the recommended management)
uterus preserving surgery (only the invaded area of myometrium is removed)
expectant management
what is expectant management in the context of a placenta accreta at c-section?
leaving the placenta inside the uterus and waiting for it to be resorbed (!!!)
what are the risks of expectant management of a placenta accreta
you’re basically deliberately leaving RPOC - bleeding and infection
what is the management of placenta accreta which is only discovered once a caesarean has already started?
you can reseal the abdomen and perform surgery at another time
