PLACENTA ACCRETA

 . With this complication. Normally. the point of attachment extends to the layers of myometrium. chorionic villi attaches to the uterine endometrium.Definition :  Placenta Accreta is an intrapartum complication characterized by the abnormal implantation of the placenta.

“Myo” denotes muscle.Review of Related Anatomy and Physiology     Uterus. Perimetrium – the outermost layer that covers the uterus. myometrium and endometrium. houses the fetus until delivery.  . Endometrium – the innermost layer that responds to hormonal variations (estrogen and progesterone) during the menstrual cycle. This structure has three layers namely: the perimetrium. thus. this layer contains thick muscular layers. (“Peri” means outside) Myometrium – located at the middle part of uterus. the pear-shaped hollow muscular organ.

(“Endo” means inside)  In a female reproductive cycle.  . The chorionic villi (finger-like projections that attaches to the uterine wall) penetrates into this portion of the uterus during implantation. With  fertilization. the uterine endometrium normally sloughs off the thickened vascular surface that precedes the actual secretion of blood flow. it continues to be crammed with blood to accommodate and nourish the embryo.

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 so it Penetrates)  . (Pancreta starts with letter P. (Increta starts with letter I. so it Invades/Infiltrates) Palcenta Pancreta/Percreta – chorionic villi penetrates beyond the myometrium into the entire uterine wall and possibly to other adjacent organs such as the bladder. This is the least common of the three conditions. This is the most common form of the condition.Types of Placenta Accreta     This obstetric complication is categorized depending on the depth of its attachment: Placenta Accreta – chorionic villi attaches deeply into the uterine wall but does not penetrate the myometrium. so it Attaches) Placenta Increta – chorionic villi invades or infiltrates the muscular layer. (Accreta starts with letter A.

into the myometrium. .Type Description Percent placenta accreta placenta increta An invasion of the  75­78% myometrium which does  not penetrate the entire  thickness of the muscle.  This form of the  Occurs when the  condition accounts for  17% placenta further extends  around 75% of all cases.

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 other  organs such as the  rectum or bladder .

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Myomectomy)  Thin decidua or absent deciduas basalis  Presence of tumor  . Cesarean Section.Predisposing Factors  Scarring of tissues from previous infection  Previous uterine surgery (Dilation and Curettage.

Complications  Uterine rupture  Massive bleeding  Disseminated intravascular coagulation (DIC)  Diagnostic test  Ultrasound  MRI  .

 During labor and delivery massive bleeding is observed.Signs and Symptoms  Usually signs and symptoms are not detected until labor and delivery. However.  . In cases when deciduas basalis is absent. the placenta will not loosen and fails to be delivered. for some third trimester bleeding would be noted.

 Closure of the uterus is performed. This treatment saves the uterus but poses higher risk of complications and low successful rate.  . Techniques for this treatment are as follows:  The placenta is left in the uterus and the cord is ligated.Medical Management Conservative treatment is done if the woman wants to maintain her fertility under the condition that no active bleeding is present.

Treatment  The safest treatment is a planned caesarian section and abdominal hysterectomy if placenta accreta is diagnosed before birth  If it is important to save the woman's uterus (for future pregnancies) then resection around the placenta may be successful  If the woman decides to proceed with a vaginal delivery. blood products for transfusion should be prepared. .

Methotrexate (an antineoplastic agent) is usually 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 after the initiation of treatment)  Blood Urea Nitrogen (BUN). Creatinine. and urine pH (should be above 7.0)  Presence of dry and nonproductive cough may be an early sign of pulmonary toxicity    .

   Prepared by: Demi Rose Z. Bolivar L-BSN3A .

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