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

Abstract

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

Placenta Accreta Spectrum: An Alarming Situation in Pakistan

“…Placenta accreta is term used when placenta is morbidly adherent with uterus [1]. It occurs due to absence of decidua basalis which results in invasion of placenta to substance of uterus [2][3][4]. This Condition is classified as; 1) Placenta accreta 82%: Placenta implants totally/partially or focally through the decidua basalis.…”

“…The incidence of this condition has increased 10 folds in the past 50 years and seems to parallel the rising rate of cesarean deliveries. In 1980 incidence was 1 in 2500 deliveries, In 2012 American college of obstetrics and gynaecogist states that its rate becomes 1 in 533 [1,4,6,7].…”

“…The known risk factors include [1,4,[8][9][10][11] Previous cesarean section, placenta previa, advanced maternal age, multiparty, previous myomectomy, uterine curettage, thermal ablasion, uterine artery embolization, smoking, uterine anomalies.…”