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 LACENTA ACCRETA

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:efinition  

Placenta Accreta is an intrapartumcomplication characterized by

the abnormal implantation of theplacenta. Normally, chorionic villiattaches to the uterineendometrium. With this

complication, the point of attachment extends to the layersof myometrium.

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eview of Related Anatomy

 nd Physiology 

Uterus, the pear-shaped hollow muscular organ,houses the fetus until delivery. This structure has

three layers namely: the perimetrium,myometrium and endometrium.

Perimetrium – the outermost layer that covers theuterus. (“Peri” means outside)

Myometrium – located at the middle part of uterus.

“Myo” denotes muscle, thus, this layer containsthick muscular layers.

Endometrium – the innermost layer that respondsto hormonal variations (estrogen andprogesterone) during the menstrual cycle.

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The chorionic villi (finger-likeprojections that attaches to the

uterine wall) penetrates into thisportion of the uterus duringimplantation. (“Endo” means inside)

In a female reproductive cycle, the

uterine endometrium normallysloughs off the thickened vascularsurface that precedes the actualsecretion of blood flow. With

fertilization, it continues to becrammed with blood to accommodateand nourish the embryo.

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Type Descript ion Percent

 lacentaaccreta

  An invasion of the

myometrium which does

not penetrate the entire

thickness of the muscle.

This form of thecondition accounts for

around 75% of all cases.

75 78%

 placenta increta Occurs when the

placenta further extends

into the myometrium.

17%

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Type Description Percent

 placenta percreta The worst form of the

condition is when the

placenta penetrates

the entire myometrium

to the uterine serosa (invades through

entire uterine wall).

This variant can lead

to the placenta

attaching to otherorgans such as the

rectum or bladder

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 re disposing Fa ctors  

Scarring of tissues from previousinfection

Previous uterine surgery (Dilationand Curettage, Cesarean Section,Myomectomy)

 Thin decidua or absent deciduasbasalis

Presence of tumor

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Complications 

Uterine ruptureMassive bleeding

Disseminated intravascular

coagulation (DIC)  Diagnostic test

Ultrasound

MRI

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 igns and Symptoms 

Usually signs and symptoms are notdetected until labor and delivery.However, for some third trimester

bleeding would be noted.During labor and delivery massive

bleeding is observed. In cases whendeciduas basalis is absent, the

placenta will not loosen and fails to bedelivered.

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Medical Management 

Conservative treatment is done if the womanwants to maintain her fertility under thecondition that no active bleeding is present.

 This treatment saves the uterus but poseshigher risk of complications and lowsuccessful rate. Techniques for thistreatment are as follows:

 The placenta is left in the uterus and the cordis ligated.

Closure of the uterus is performed.

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Treatment

 The safest treatment is a plannedcaesarian section and abdominalhysterectomy if placenta accreta is

diagnosed before birth If it is important to save the woman's

uterus (for future pregnancies) thenresection around the placenta may be

successful If the woman decides to proceed with a

vaginal delivery, blood products fortransfusion should be prepared.

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Methotrexate (an antineoplastic agent) isusually given to the woman to destroy the

still attached placenta. Women taking Methotrexate should be

monitored for:

WBC and platelet count (thrombocytopenia

and leucopenia may occur 7-14 days afterthe initiation of treatment)

Blood Urea Nitrogen (BUN), Creatinine, andurine pH (should be above 7.0)

Presence of dry and nonproductive cough maybe an early sign of pulmonary toxicity

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Prepared by: Demi Rose Z. Bolivar L-BSN3A