Placenta accreta

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Background

Normal placental anatomy.
  • 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[1]

  • 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

>20 Weeks

Any time

Evaluation

Management

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

Disposition

  • Admit

See Also

References