Placenta Accreta

Question 0

Placenta increta?

Answer 0

Abnormally implanted placenta penetrates into myometrium

Question 1

Placenta accreta? Abnormality of what layer? Histology?

Answer 1

Abnormal adherence of the placenta to the uterine wall – due to an animality of the decidua basalis (placental villi are attached to the myometrium)

Question 2

Placenta percreta? Common complication?

Answer 2

Abnormally implanted placenta penetrates entirely through myometrium and into serosa

Invasion into bladder

Question 3

Risk factors for placental adherence?

Answer 3

1. Anterior/Low lying placenta
2. Placenta previa
3. Prior C-section or uterine scar
4. Uterine curettage or Prior myomectomy
5. Fetal down syndrome

Question 4

Differentiating complete versus incomplete placenta accreta

Answer 4

No bleeding versus antepartum bleeding

Question 5

Initial management hope retained placenta? Finding of placenta accreta ? Do not try?

Answer 5

Manual extraction with effort to find cleavage plane between placenta uterus

No cleavage plane between placenta and uterus

D&C – can cause hemorrhage and exsanguination

Question 6

Transmigration of the placenta?

Answer 6

Rapid growth of lower uterine segment (in a low lying placenta) during the third trimester

Question 7

50% risk for placenta accreta if?

Answer 7

3+ prior C-sections with placenta previa

Question 8

Treatment of placenta accreta? If Patient refuses? Side effects?

Answer 8

Hysterectomy

Location of umbilical cord is highest possible and IV methotrexate (hemorrhage and infection)