UW placenta accreta 02-18 (1)

Question 1

UW. placenta accreta table. definition?

Answer 1

morbidly adherent placental attachement to the myometrium

Question 2

UW. placenta accreta table. risk factors?

Answer 2

Placenta previa + prior uterine surgery (eg S/c, DandC, myomectomy)

Question 3

UW. placenta accreta table. CP. prenatal Dx?

Answer 3

US with placenta previa, numerous placental lacunae, myometrial thinning

Question 4

UW. placenta accreta table. CP. postpartum Dx?

Answer 4

adherent placenta, postpartum hemorrhage

Question 5

UW. placenta accreta table. Mx?

Answer 5

cesaren hysterectomy with placenta in situ

Question 6

placenta accreta, or pathologic attachment of placental villi directly to the uterine myometrium rather than the uterine decidua (ie, uterine endometrium modified for pregnancy).

Answer 6

.

Question 7

This abnormal placentation likely occurs due to …..?

Answer 7

Defective or absent endometrial decidualization in areas with scarring from prior uterine surgery (eg, cesarean delivery, dilation and curettage).

The lack of normal decidua in these areas allows the chorionic villi to attach to the myometrium and become morbidly adherent.

Question 8

UW. Placenta accreta is typically diagnosed on ….

Answer 8

routine second-trimester ultrasound

Question 9

UW. Placenta accreta. Mx usually …..? what and when? and why?

Answer 9

planned cesarean hysterectomy (prior to the onset of spontaneous labor) due to the significant risk for postpartum hemorrhage

Question 10

UW. in some cases (eg, limited prenatal care), the diagnosis of placenta accreta is made only after fetal delivery, when there is significant difficulty detaching the placenta from the uterine wall.

Answer 10

.

Question 11

UW. Attempts to remove the placenta (eg, manual placental extraction, sharp uterine curettage) are usually ……. and incr. risk for ……??

Answer 11

unsuccessful (due to dense adhesions between the placenta and uterus) and can significantly increase bleeding;

Question 12

UW. should we remove placenta in placenta accreta?

Answer 12

removal of the placenta is contraindicated due to high risk of bleeding

Question 13

UW. since plancenta accreta can cause severe postpartum hemorrhage, hemorrhagic shock, consumptive coagulopathy, and maternal death, best next step in mx is??

Answer 13

Surgical removal of the uterus (ie, hysterectomy) with the placenta in situ (ie, remaining attached to the uterine wall), which minimizes further maternal blood loss

Question 14

UW. if placenta accreta is Dx on routine UG, what is Mx?

Answer 14

planned cesarean hysterectomy (prior to the onset of spontaneous labor) due to the significant risk for postpartum hemorrhage.

Question 15

UW. placenta accreta + concomitant what condition?

Answer 15

concomitant placenta previa because prior uterine surgery can decrease fundal perfusion and promote abnormal placentation in the lower uterus (eg, low-lying placenta

Question 16

UW. placenta accreta the main risk for what complication?

Answer 16

POSTPARTUM HEMORRHAGE