placenta accreta

Question 1

what

Answer 1

placenta implants deeper through and past endometrium

makes it difficult to separate placenta after delivery of baby

Question 2

where does placenta usually attatch

Answer 2

endometrium

Question 3

superficial placenta accreta

Answer 3

placenta implants in the surface of myometrium but not beyond

Question 4

placenta increta

Answer 4

placenta attaches deeply into myometrium

Question 5

placenta percreta

Answer 5

placenta invades past myometrium and perimetrium

potentially reaches other organs e.g. bladder

Question 6

risk factors

Answer 6

previous placenta accreta
prev endometrial currettage procedure e.g. miscarriage, TOP 
prev CS
multigravida
inc maternal age 
low lying placenta/placenta praeivia

Question 7

presentation

Answer 7

APH 3rd trimester
antenatal USS
difficult to deliver placenta at birth –> PPH

Question 8

Mx - delivery planning

Answer 8

35-36+6

antental steroids

Question 9

options during CS

Answer 9

hysterectomy - recommended

uterus preserving surgery - resect part of myometrium with placenta

expectant management

Question 10

Mx - placenta accreta seen when opening abdo for elective CS

Answer 10

abdomen closed and delay delivery whilst specialist services put in place

Question 11

Mx - placenta accreta discovered after delivery

Answer 11

hysterectomy is recommended