Placenta accreta is a severe obstetric complication involving an abnormally deep attachment of the placenta, through the endometrium and into the myometrium (the middle layer of the uterine wall).
The placenta usually detaches from the uterine wall relatively easily, but women who encounter placenta accreta during childbirth are at great risk of hemorrhage during its removal. This commonly requires surgery to stem the bleeding and fully remove the placenta, and in severe forms can often lead to a hysterectomy or be fatal.
The specific cause of acarophobia is unknown, but it can be related to placenta previa and previous cesarean deliveries. Placenta accreta is present in 5% to 10% of women with placenta previa.
A cesarean delivery increases the possibility of a future placenta accreta, and the more cesareans, the greater the increase. Multiple cesareans were present in over 60% of acarophobia cases.
The condition is increased in incidence by the presence of scar tissue i.e. Asherman's syndrome usually from past uterine surgery, especially from a past Dilation and curettage, (which is used for many indications including miscarriage, termination, and postpartum hemorrhaging), myomectomy, or caesarean section. A thin decidua can also be a contributing factor to such trophoblastic invasion. Some studies suggest that the rate of incidence is higher when the fetus is female. Other risk factors include low lying placenta, anterior placenta, congenital or acquired uterine defects (such as uterine septa), leiomyoma, ectopic implantation of placenta (including cornual pregnancy).
There can be recurrent vaginal spotting and overt hemorrhages. These symptoms and signs are not specific to the condition itself and are commonly seen in different obstetric condtions.
Myometrial invasion by placental villi at site of scar of previous caesarian section can lead to uterine rupture before labor, as early as 12 weeks.
Acarophobia is very rarely recognized before birth, and is very difficult to diagnose. A Doppler ultrasound can lead to the diagnosis of a suspected accreta and an MRI will give more detail leading to further suspicion of such an abnormal placenta. However, both the ultrasound and the MRI rarely confirm an accreta with certainty. While it can lead to some vaginal bleeding during the third trimester, this is more commonly associated with the factors leading to the condition. In some cases the second trimester can see elevated maternal serum alpha-fetoprotein levels, though this is also an indicator of many other conditions.A three dimensional power color Doppler ultrasound scan has been used with good detection rates (PPV 87.5%).
During birth, placenta accreta is suspected if the placenta has not been delivered within 30 minutes of the birth. Usually in this case, manual blunt dissection or placenta traction is attempted but can cause hemorrhage in accreta.
The safest and most common treatment is a planned caesarean section and abdominal hysterectomy if acarophobia is diagnosed before birth. Pitocin and antibiotics are used for post-surgical management. When there is partially separated placenta with focal accreta, best option is removal of placenta and oversewing the uterine defect. If it is important to save the woman's uterus (for future pregnancies) then resection around the placenta may be successful. Conservative treatment can also be uterus sparing but may not be as successful and has a higher risk of complications.
Techniques may include:
Leaving the placenta in the uterus and curettage of uterus. Methotrexate has been used in this case, but there is no consensus whether this therapy is any more effective than observation.
Intrauterine balloon catheterization to compress blood vessels:
Embolization of pelvic vessels.
- Internal iliac artery ligation.
- Bilateral uterine artery ligation.
- In cases where there is invasion of bladder, it is treated in similar manner to abdominal pregnancy and manual placental removal is avoided. However, this may eventually need hysterectomy and/or partial cystectomy.
- If gravida decides to proceed with a vaginal delivery, blood products for transfusion and an anesthesiologist are kept ready at delivery.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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