*Placental invasive disorders

Question 1

Define abnormal placentation (placenta accreta spectrum - PAS)

Answer 1

When the placental villi penetrate deeper than the decidua basalis (i.e. placenta grows into next layer i.e. into the myometrium)

The area of adherence may be:
- Focal
- Partial or
- Total

Question 2

Placenta accreta

Answer 2

Chorionic villi ADHERE to myometrium

Question 3

Placenta increta

Answer 3

Chorionic villi DEEPLY INVADE the myometrium / extend into myomrtrium

Question 4

Placenta percreta

Answer 4

Placental villi invade the FULL THICKNESS of the myometrium through the serosal layer of the uterus (with potential for invasion of adjacent organs)

Potential invasion of adjacent organs

Question 5

Predisposing factors for placental invasive disorders

MOM PP

Answer 5

• multiparous women
• older women
• multiple pregnancy
• previous CS
• previous or current placenta previa

Question 6

Management

Answer 6

• Multidisciplinary planning (if known antenatally)
• Manual removal if focal or partial adhesion
• May be left in situ to be reabsorbed
• Ligate main artery to uterus before delivery of placenta
• Hysterectomy (life-saving last resort)
• Adequate supplies of cross-matched blood