Obstetrics and Gynecology

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Placenta Accreta

What is placenta accreta?

A delay in the delivery of the placenta because it is abnormally adhered to the uterine lining.

What causes placenta accreta?

Under normal circumstances, the placenta implants itself on the surface of the uterine lining. However if the placenta invades the lining of the uterus, it cannot be removed at the time of the delivery. A placenta that has grown into (or through) the uterine wall is a placenta accreta variant. The most severe form, placenta percreta, involves placental growth through the entire wall of the uterus into the surrounding tissues. Patients at risk for this include those who have had multiple cesarean sections, fibroid removals that involved going into the uterine cavity, aggressive D&C (scraping), endometrial ablation and prior uterine artery embolization therapy.

What are the symptoms of placenta accreta?

Little to no bleeding following birth of the fetus and no natural separation leading to delivery of the placenta within 30 minutes.

How is placenta accreta diagnosed?

Prior to ultrasound diagnosis, placenta accreta was diagnosed at the time of delivery and attempts to remove the placenta would lead to profuse hemorrhage, requiring emergent hysterectomy to preserve the mother’s life. Now placenta accreta can be diagnosed with an ultrasound during pregnancy.

What is the treatment for placenta accreta?

Previously a patient with a known placenta accreta would undergo a hysterectomy at the time of the cesarean section. With the advances in medical and surgical management, other options for uterine preservation are available.

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