Placenta accreta

Question 1

Definition of placenta accreta

Answer 1

Abnormal attachment of placenta as a result of defective decidual formation, leads to absent decidual plate causing trophoblastic invasion to extend beyond the decidual layer into the uterine myometrium
- Absent Nitabuch layer

Question 2

Classification of placenta accreta

Answer 2

According to invasiveness into uterine wall
- Placenta accreta: anchoring villi closely adhere to the superficial myometrium
- Placenta increta: placental villi invade the myometrium - Placenta percreta: placental villi invade the myometrium and through the uterine wall, extending to the serosa, surrounding tissues, and organs

Question 3

Complications of placenta accreta

Answer 3

PPH
Uterine rupture

Question 4

Risk factor of placenta accreta

Answer 4

Low lying placenta (especially anterior placenta)
+ Previous LSCS/uterine surgery
(grows on scarred area of prevision incision site)

Question 5

Management of placenta accreta

Answer 5

If emergency: Surgical hysterectomy

If desire fertility: Post-Csect hysteroscopic resection of placental remnants KIV hysterectomy