Placenta Accreta Flashcards
Placenta Accreta
When the placenta implants deeper, through and past the endometrium
Complication of placenta accreta
Difficult to separate the placenta after delivery of the baby therefore risk of post partum haemorrhage
Layers of the uterus
Endometrium
Myometrium - smooth muscle
Serosa
Superficial placenta accreta
Where the placenta implants in the surface of the myometrium, but not beyond
Placenta increta
Where the placenta attaches deeply into the myometrium
Placenta percreta
Where the placenta invades past the myometrium and perimetrium, potentially reaching other organs such as the bladder
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
Presentation of placenta accreta
Typically asymptomatic
May get antepartum bleeding in the third trimester
How is placenta accreta diagnosed
USS
Or at birth when there is difficulty delivering the placenta - can cause postpartum haemorrhage
Management of placenta accreta
When diagnosed early by USS: planned delivery
Specialist MDT
Investigations for placenta accreta
USS for diagnosis
MRI - assess depth and width of invasion
What may be required when delivering the baby for women with placenta accreta
Complex uterine surgery
Blood transfusions
Intensive care for the mother
Neonatal intensive care
Planned delivery for placenta accreta
Planned between 35 to 36 + 6 weeks gestation to reduce the risk of spontaneous labour and delivery
Corticosteroids given
Options during caesarean for placenta accreta
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
Risks of expectant management
Bleeding
Infection
