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Placenta accreta

Placenta accreta. Definition.

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Placenta accreta

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  1. Placenta accreta

  2. Definition Placenta accreta occurs when there is a defect of the decidua basalis, in conjunction with an imperfect development of the Nitabuch membrane (a fibrinoid layer that separates the decidua basalis from the placental villi) resulting in abnormally invasive implantation of the placenta The ACOG committee

  3. According to Mudhaliar and Menon Placenta accreta is defined as the abnormal adherence,either in whole or in part,of the afterbirth to the unlying uterine wall. According to D.C.Dutta Placenta accreta in extremely rare form in which the placen is directly anchored to the myometrium partially or completely thout any intervening decidua.

  4. Incidence • From 1930 to 1950--one case in 30,000 deliveries. • From 1950 to 1960, one in 19,000, deliveries. • by 1980 to one in 7,000. • the incidence has now risen to one in 2,500 deliveries The ACOG committee

  5. Degrees of severity/ Types of Placenta Accreta • (1) Accreta, in which the placenta adheres to the myometrium without invasion into the muscle. • (2) Increta, in which it invades into the myometrium. • (3) Percreta, in which it invades the full thickness of the uterine wall and possibly other pelvic structures, most frequently the bladder.

  6. Depending on the area of involvement • Total • Partial • Focal

  7. Risk factors • Placenta previa with or without previous uterine surgery. • previous myomectomy. • previous cesarean delivery. • Asherman's syndrome. • submucous leiomyomata. • maternal age of 36 years and older.

  8. Etiology • Defective decidual formation • Implantation in lower uterine segment • Caesarean scar • Uterine incision or curettage • Manual removal of placenta • Abortive agents • Uterine infections

  9. Clinical Course • Maternal Serum Alpha Fetoprotein level - increased • Ante partum hemorrhage • Uterine rupture before labour

  10. Diagnosis Ultrasound • loss of the normal hypoechogenic zone between the placenta and myometrium • abnormality of the smooth interface between the uterus and bladder • a Swiss-cheese appearance to the placenta, • pulsatile flow of maternal blood MRI

  11. Swiss cheese appearance

  12. Management Partial Morbid Adherent Placenta • “Playing with the placenta with fingers” • Oxytocics • Intrauterine plugging • Hysterectomy

  13. Total Placenta Accreta • Hysterectomy • Conservative : • Cutting umbilical cord • Antibiotics Other measures • Blood replacement • Uterine and internal iliac artery ligation • Angiographic embolization • Argon beam coagulation

  14. A tiny angiographic catheter is maneuvered into the uterine artery in preparation for embolization

  15. Complications • Hemorrhage • Shock • Infection • Sub involution of uterus • Secondary postpartum hemorrhage • Formation of placental polyp

  16. Thank you

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