An unusual presentation of placenta accreta

Khan, AM; Dawlatly, Bashir; Khan, Dawood; Deol, Navreet

doi:10.1080/01443610410001648359

Cited by 2 publications

(2 citation statements)

References 3 publications

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“…The false-positive and false-negative rates range from 2 to 25% using a trans-abdominal ultrasound approach. A trans-vaginal approach is usually superior, as it enables avoidance of the fetal head and higher resolution images 13,14,15 . …”

Section: Diagnosismentioning

confidence: 99%

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Management of morbidly adherent placenta

Herath

Wijesinghe

2012

Sri Lanka J Obstet & Gynae

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Morbidly adherent placenta is a rare complication of human placentation that may threaten maternal life due to massive haemorrhage. Its incidence is increasing due to the rising caesarean section rates worldwide. A high degree of clinical suspicion coupled with ultrasonography, magnetic resonance imaging, and cystoscopy helps in antenatal diagnosis. Elective caesarean hysterectomy with a multidisciplinary approach is the conventional treatment for confirmed cases of morbidly adherent placenta. However more conservative fertility saving approaches are also used successfully. IntroductionMorbidly adherent placenta (MAP) occurs when there is a defect in the decidua basalis, resulting in an abnormal invasion of the placenta into the substance of the uterus. As a result, there is no clear plane of cleavage between the placenta and the underlying uterus. Depending on the extent of adherence and invasion of the placenta the condition is classified as placenta accreta (reaching the myometrium), placenta increta (into the myometrium) and placenta percreta (right through the myometrium to breach the serosa or beyond) 1 . In the literature the term "placenta accreta" is often used interchangeably as a general term to describe all three conditions. Morbidly adherent placenta is thought to be due to an absence or deficiency of Nitabush's layer or the spongiosus layer of the decidua. Benirschke et al suggested this to happen as a consequence of failure of reconstitution of the decidua basalis after repair of caesarean incision, thus resulting in absence of intervening decidual tissue between the invading trophoblast and the myometrium 2 . It has been proposed that the abnormality of the placental uterine interface leads to leakage of fetal alpha-fetoproteins into the maternal circulation resulting in elevated levels of maternal serum alpha-fetoproteins 3,4 . Management of morbidly adherent placenta R P Herath 1 , P S Wijesinghe

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Section: Diagnosismentioning

confidence: 99%

“…Most case reports indicate that the mid-trimester presentation of MAP could be in the form of uncontrollable vaginal bleeding or uterine rupture, causing intraperitoneal bleeding. Some are detected only following second trimester miscarriage or evacuation of retained products of conception 13 .…”

Section: Introductionmentioning

confidence: 99%

Management of morbidly adherent placenta

Herath

Wijesinghe

2012

Sri Lanka J Obstet & Gynae

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Lessons Learnt from Two Women with Morbidly Adherent Placentas and a Review of Literature

Thia

Tan

Devendra

et al. 2007

Ann Acad Med Singap

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Introduction: Pathologically adherent placentas occur when there is a defect of the decidua basalis, typically arising from previous caesarean section, resulting in abnormally invasive implantation of the placenta. The depth of placental invasion varies from the superficial (accreta), to transmural and possibly beyond (percreta). Clinical Picture: We report on 2 cases, one treated “conservatively”, the other with a caesarean hysterectomy, both of which led to a safe outcome for both mother and baby. Conclusions: Management relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric haemorrhage at delivery. Key words: Management, Obstetric haemorrhage, Placenta accreta, Placenta percreta, Placenta increta

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An unusual presentation of placenta accreta

Cited by 2 publications

References 3 publications

Management of morbidly adherent placenta

Management of morbidly adherent placenta

Lessons Learnt from Two Women with Morbidly Adherent Placentas and a Review of Literature

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