Placenta Accreta Flashcards

1
Q

Definition

A

When the placenta implants deeper, through and past the endometrium, making it difficult to separate the placenta after delivery of the baby.

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2
Q

Why is it referred to as placenta accreta spectrum

A

As there is a spectrum of severity in how deep and broad the abnormal implantation extends

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3
Q

Anatomy of uterus

A

There are three layers of the uterine wall
- Endometrium = inner layer, contains connective tissue (stroma), epithelial cells and blood vessels
- Myometrium, the middle layer that contains smooth muscle
- Perimetrium, the outer layer, which is a serous membrane similar to the peritoneum (also known as serosa)

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4
Q

Superficial placenta accreta

A

Where the placenta implants in the surface of the myometrium, but not beyond

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5
Q

Placenta increta

A

Where the placenta attaches deeply into the myometrium

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6
Q

Placenta percreta

A

Where the placenta invades past the myometrium and perimetrium, potentially reaching other organs such as the bladder

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7
Q

Risk factors

A
  • Previous placenta accreta
  • Previous endometrial curettage procedures (e.g. for miscarriage or abortion)
  • Previous caesarean section
  • Multigravida
  • Increased maternal age
  • Low-lying placenta or placenta praevia
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8
Q

Clinical features

A

ASx
- Can present with bleeding (anterpartum haemorrhage) in third trimester

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9
Q

Diagnosis

A

Antenatal USS scan
- Attention given to women with a previous P.A or C-section during scanning
Can be diagnosed at birth, when it becomes difficult to deliver the placenta = cause significant postpartum haemorrhage.
MRI = can be used to assess depth and width of the invasion

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10
Q

Management

A

Additional management at birth to prevent risk of bleeding:
- Complex uterine surgery
- Blood transfusions
- Intensive care for mothers
- Neonatal intensive care

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11
Q

Birth plan

A

Delivery planned between 35-36 + 6 weeks to reduce risk of spontaneous labour and delivery.
Antenatal steroids = mature lungs
The options during caesarean are:
- Hysterectomy with placenta remaining in the uterus (recommended)
- Uterus preserving surgery, with resection of part of the myometrium along with the placenta
- Expectant management, leaving the placenta in place to be reabsorbed over time.

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12
Q

Expectant management

A

RCOG guideline (2018) = when opening the abdomen in elective c-section, if P.A seen = the abdomen can be closed and delivery delayed whilst specialist services put in place.
- If placenta accreta is discovered after delivery of the baby, a hysterectomy is recommended.

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