Table Of Contents
Placenta accreta spectrum
Placenta accreta is a condition whereby the placenta attatches too deeply into the uterine wall. It is characterized by obliteration of Nitabuch’s fibrinoid layer, which acts as a barrier to trophoblastic invasion beyond the decidua.
The principles of management incude early diagnosis and appropriate referral since 2/3 of the cases with a morbidly adherent placenta require caesarean delivery and hysterectomy. Of these cases, blood should be on hand since the average blood loss with a morbidly adheren placenta is 3-5 L.
| Abnormal placentation | Description |
|---|---|
| Placenta accreta (75 – 78%) | Placenta villi invade beyond Nitabuch’s layer and into the deep layers of the decidua basalis |
| Placenta increta (17%) | Placenta vili partially invade into the myometrium |
| Placenta percreta (5 – 7%) | Placenta vili invade completely through the myometrium and occasionally to the serosa and beyond (bladder) |
- Treatment
- Manual removal of the placent in focal morbid adherent placenta
- Hysterectomy in total placenta accreta if the woman has completed her family
