Placenta accreta


Placenta accreta

Description, Causes and Risk Factors:

The abnormal adherence of the chorionic villi to the myometrium, associated with partial or complete absence of the decidua basalis and, in particular, the stratum spongiosum.

The placenta normally attaches to the uterine wall, however there is a condition that occurs where the placenta attaches itself too deeply into the wall of the uterus. This condition is known as placenta accreta. Approximately Placenta accreta affects approximately 1 in 533 pregnancies.

The specific cause of placenta accreta 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 placenta accreta cases.

Risk Factors:

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 (D&C), 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).

Symptoms:

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 conditions.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.

Premature delivery and subsequent complications are the primary concerns for the baby. Bleeding during the third trimester may be a warning sign that placenta accreta exists, and when placenta accreta occurs it commonly results in a premature delivery. Your healthcare provider will examine your condition and use medication, bed rest and whatever else necessary to help continue the pregnancy towards full term.

Diagnosis:

Placenta accreta 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. 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.

Treatment:

There is nothing a woman can do to prevent placenta accreta, and there is little that can be done for treatment once placenta accreta has been diagnosed. If you have been diagnosed with placenta accreta your healthcare provider will monitor your pregnancy with the intent of scheduling a delivery and using a surgery that may spare the uterus. It is particularly important to discuss this surgery with your doctor if you desire to have additional children.

Unfortunately, placenta accreta may be severe enough that a hysterectomy may be needed. Again, it is important to discuss surgical options with your healthcare provider.

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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