Placenta accreta spectrum (Complete) Flashcards
Define placenta accreta spectrum (PAS)
Group of disorders characterised by abnormal placental attachment or invasion into the uterine wall
What are the main subtypes of PAS?
Placenta accreta
Placenta increta
Placenta percreta
Define placenta accreta
Placenta adheres to superficial myometrium
Define placenta increta
Invasion of placental villi into but not through myometrium
Define placenta percreta
Full-thickness invasion of placental villi through myometrium to the serosa
Placenta percreta is associated with increased risk of what uterine complication?
Uterine rupture
What are the main risk factors of PAS?
Previous C-section
Previous termination of pregnancy
Any previous uterine surgeries
Advanced maternal age
Multiparity
Ashermans syndrome
Placenta praevia
Structual uterine abnormalities
What are the main clinical features of placenta accreta?
Antenatal:
Assymptomatic and picked up on imaging
Persistent placental praevia (may indicate PAS)
Intrapartum:
Difficulty delivering the placenta
Severe haemorrhage during or after delivery
What investigation is diagnostic for PAS?
Transvaginal USS
What findings can be seen on TV USS in patients with PAS?
Thickened placental-myometrial interface
Vascular lacunae within the placenta
When is MRI indicated in PAS?
Used to assess depth of invasion, especially useful in cases of placenta percreta
What is the management plan for patients with PAS?
Antenatal:
MDT
- Obstetricians
- Anaesthetists
- Neonatologists
Delivery planning at tertiary centre with access to blood products and surgical expertise
Delivery:
Elective C-section + hysterectomy
If fertility is important:
- Placental resection
- Conservative measures (placenta in situ) but increases risk of infection and delayed haemorrhage
Post-natal:
Monitoring for infection and haemorrhage
What is the best management option for PAS?
C-section with hysterectomy
What alternative options are available if fertility is important?
Placental resection
Conservative management (placenta in situ)
Leaving placenta in situ increases risk of what complications?
Infection
Delayed haemorrhage
What complications can occur in PAS?
Maternal:
Severe post-partum haemorrhage
Uterine rupture
Infection or sepsis
Infertility (hysterectomy)
Foetal:
Pre-term delivery
