Placenta accreta

Question 1

What is placenta accreta?

Answer 1

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

Question 2

What are the 3 layers of the uterine wall?

Answer 2

1. Endometrium → inner layer that contains connective tissue, epithelial cells & blood vessels.
2. Myometrium → middle layer that contains smooth muscle.
3. Perimetrium → outer layer which is a serous membrane.

Question 3

What happens to the placenta normally?

Answer 3

Usually the placenta attaches to the endometrium which allows the placenta to separate cleanly during the third stage of labour, after delivery of the baby.

Question 4

What happens in placenta accreta?

Answer 4

Placenta embeds past the endometrium into the myometrium which makes it difficult to separate during delivery, leading to postpartum haemorrhage.

Question 5

What is superficial placenta accreta?

Answer 5

Where placenta implants in surface of myometrium but not beyond.

Question 6

What is placenta increta?

Answer 6

Where placenta attaches deeply into myometrium.

Question 7

What is placenta percreta?

Answer 7

Where placenta invades past the myometrium and perimetrium, potentially reaching other organs like the bladder.

Question 8

What are the risk factors for placenta accreta?

Answer 8

1. Previous placenta accreta.
2. Previous endometrial curettage procedures (miscarriage or abortion).
3. Previous C section.
4. Multigravida.
5. Increased maternal age.
6. Low lying placenta.

Question 9

How is placenta accreta diagnosed?

Answer 9

On antenatal USS or diagnosed at birth when it becomes difficult to deliver the placenta.
MRI scans can assess the depth and width of invasion.

Question 10

What is the management at birth for placenta accreta?

Answer 10

1. Complex uterine surgery.
2. Blood transfusions.
3. Intensive care for mother.
4. Neonatal invasive care.

Question 11

When is delivery planned for placenta accreta and why?

Answer 11

Between 35 to 36 + 6 weeks gestation to reduce the risk of spontaneous labour & delivery.

Question 12

What are the options during caesarean for placenta accreta?

Answer 12

1. Hysterectomy with placenta remaining in uterus.
2. Uterus preserving surgery with resection of part of the myometrium.
3. Expectant management - leave placenta in place to be reabsorbed over time.