Placenta accreta Flashcards
What is placenta accreta spectrum?
abnormal placental adherance or invasion into the uterine wall
classified as accreta, increta, percreta
What is placental accreta?
occurs where adherence of the placenta directly to superficial myometrium but does not penetrate the thickness of the muscle.
What is placental increta?
when all villi invade into but not through the myometrium
What is placenta percreta?
when villi invade through full thickness of myometrium to the serosa.
increased risk of uterine rupture, may eveb attach to bladder /rectum
Risk factors of placenta accreta spectrums?
Previous TOP
previous CS
Previous uterine surgeries
advanced age
antenatal symptoms of placental accreta?
often asymptomatic, identified on imaging
What might persistent unchanging placenta praevia indicate?
placenta accreta instead
intrapartum symptoms of placenta accreta spectrum?
difficulty delivering placenta
severe haemorrhage during or after delivery
Investigations?
US with doppler imaging = thickened placental-myometrial interface + vasculare lucunae within placenta
MRI can be useful to assess invation depth esp for percreta.
How to manage a women with placenta accreta spectrum antenatally?
MDT (obs, anaesthethics, neonatal)
Delivery at tertiary centre with access to blood products
Management during delivery?
Elective caesarean hysterectomy for complete removal of placenta and prevention of catastrophic haemorrhage
can try less destructive resection if fertility preservation is suggeste
Complications
Severe PPH
uterine rupture
infection / sepsis
hysterectomy / infertlity
