Placenta accreta

Background

• Placenta accreta - superficial attachment to myometrium, uterus is possibly savable without hysterectomy
• Usually requires hysterectomy
  • Placenta increta - invasion of myometrium
  • Placenta percreta - penetrates myometrium, into serosa, possibly bladder
• Associated with Placental abruption

Risk factors

• Prior C-section
• Other uterine surgery
• Low lying placenta
• Placenta previa
• Grand multiparity
• Asherman syndrome

Clinical Features

• Postpartum hemorrhage, often severe, is major risk
• Typically causes no symptoms during pregnancy
• May cause vaginal bleeding in 3rd trimester
• May cause preterm labor
• Placenta may not deliver within 30 min of delivery
  • Attempts at manual separation fail due to no natural plane of separation or may cause massive bleeding

Differential Diagnosis

Abdominal Pain in Pregnancy

The same abdominal pain differential as non-pregnant patients, plus:

<20 Weeks

• Ectopic pregnancy
• First trimester abortion
  • Complete abortion
  • Threatened abortion
  • Inevitable abortion
  • Incomplete abortion
  • Missed abortion
  • Septic abortion
• Round ligament stretching
• Incarcerated uterus
• Malposition of the uterus

>20 Weeks

• Labor/Preterm labor
• Placental abruption
• Placenta previa
• Vasa previa
• Uterine rupture
• Vaginal trauma
• HELLP syndrome
• Cholestasis of pregnancy
• Chorioamnionitis
• Incarcerated uterus
• Acute fatty liver of pregnancy
• Malposition of the uterus
• Placenta accreta
• Placenta increta
• Placenta percreta

Any time

• Hemorrhagic ovarian cyst
• Fibroid degeneration or torsion
• Ovarian torsion
• Constipation

Evaluation

• Pelvic ultrasound
• CBC, T&S

Management

• Consult Ob/gyn, particularly if significant bleeding
• Resuscitate

Disposition

• Admit

See Also

• Pregnancy (main)