Antenatal Care - Placenta Accreta

Question 1

What is Placenta Accreta?

Answer 1

The placenta implants deeper through and past the endometrium which makes it difficult to separate the placenta after delivery of the baby.

Question 2

Why is Placenta Accreta also known as a spectrum?

Answer 2

Based on severity in terms of how deep and broad the abnormal implantation extends.

Question 3

What is Superficial Placenta Accreta?

Answer 3

Placenta implants in the surface of the myometrium, but not beyond.

Question 4

What is Placenta Increta?

Answer 4

Placenta attaches deeply into the myometrium.

Question 5

What is Placenta Percreta?

Answer 5

Placenta invades past the myometrium and perimetrium, potentially reaching other organs such as the bladder.

Question 6

Risk Factors of Placenta Accreta (6).

Answer 6

1. Previous Placenta Accreta.
2. Previous Endometrial Curettage Procedure.
3. Previous C-Section.
4. Multigravida.
5. Increased Maternal Age.
6. Low-Lying Placenta/Placenta Praevia.

Question 7

Layers of Uterine Wall (3).

Answer 7

1. Endometrium - Inner Layer with Connective Tissue, Epithelium and Blood Vessels.
2. Myometrium - Middle Layer with Smooth Muscle.
3. Perimetrium - Outer Layer with Serous Membrane.

Question 8

Physiology of Placenta and Uterine Wall.

Answer 8

The placenta attaches to the endometrium and can separate cleanly during the 3rd Stage of Labour.

Question 9

Pathophysiology of Placenta Accreta.

Answer 9

Defect in Decidua Basalis.

Question 10

Clinical Features of Placenta Accreta (2).

Answer 10

1. Asymptomatic During Pregnancy.

2. Bleeding - APH in 3rd Trimester.

Question 11

Investigations of Placenta Accreta.

Answer 11

1. Diagnosis : Antenatal US Scans or at Birth.

2. MRI Scans : Assess Depth and Width of Invasion.

Question 12

Management of Placenta Accreta (2D).

Answer 12

1. MDT Approach.
2. Additional Measures :
   A. Complex Uterine Surgery.
   B. Blood Transfusions.
   C. Intensive Care for Mother.
   D. Neonatal Intensive Care.

Question 13

When is Delivery planned?

Answer 13

Between 35 and 36+6 weeks to reduce risk of spontaneous labour and delivery.

Question 14

Options during C-Section (3).

Answer 14

1. Hysterectomy (with Placenta Remaining in Uterus).
2. Uterus-Preserving Surgery (Part of Myometrium with Placenta).
3. Expectant (Leaving Placenta to be Resorbed Over Time).

Question 15

What are the RCOG Guidelines on Placenta Accreta? (2)

Answer 15

1. Discovered after Delivery of Baby : Hysterectomy.

2. Discovered during Elective C-Section : Close Abdomen and Delay Delivery.

Question 16

Complication of Placenta Accreta.

Answer 16

1. Post-Partum Haemorrhage.
2. Preterm Delivery.
3. Uterine Rupture.