Basics of Placenta Accreta
What is placenta accreta?
Abnormal attachment of the placenta to the uterine wall, invading too deeply.
What is the number one risk factor for placenta accreta?
Previous cesarean delivery.
What imaging technique is most commonly used to diagnose placenta accreta?
Ultrasound.
What is the most common complication of placenta accreta during delivery?
Severe hemorrhage.
What is the definitive treatment for placenta accreta?
Cesarean hysterectomy (removing the uterus with the placenta left inside).
Name the three types of abnormal placental attachment.
Placenta accreta, increta, and percreta.
Name one maternal age-related risk factor
Advanced maternal age (≥35 years).
What ultrasound finding is suggestive of placenta accreta?
Loss of the normal hypoechoic zone, placental lacunae (“Swiss cheese” appearance), or turbulent blood flow on Doppler.
What is the main reason for high maternal mortality in placenta accreta cases?
Uncontrollable blood loss leading to shock.
Planned delivery is usually scheduled around how many weeks gestation for accreta cases?
34–36 weeks, before labor starts.
What layer of the uterus is the placenta abnormally attached to in placenta accreta?
The myometrium (instead of detaching cleanly from the decidua).
How does the number of prior cesarean deliveries influence the risk of placenta accreta?
The risk increases with each C-section (higher scars = higher chance).
If ultrasound is inconclusive, what imaging test can be used for confirmation?
MRI
Name one fetal complication associated with placenta accreta.
Preterm birth (due to early delivery), low birth weight, or neonatal respiratory distress.
Why is a multidisciplinary team (OB, anesthesiology, urology, etc.) required for management?
Because surgery is high-risk and may involve blood loss, organ injury, and complex anesthesia.
Placenta percreta is the most severe form. What does “percreta” mean?
The placenta invades through the myometrium and can attach to other organs (e.g., bladder).
Besides C-sections, name two other uterine surgeries that increase the risk.
Dilation & curettage (D&C), myomectomy, or endometrial ablation.
Placenta accreta is often discovered when a patient has what type of condition during pregnancy?
Placenta previa.
Placenta accreta can lead to hysterectomy. What is a hysterectomy?
Surgical removal of the uterus.
What is conservative management, and when might it be considered?
Leaving the placenta in place to allow natural resorption or delayed removal, considered if fertility preservation is desired and bleeding is controlled.
Why is placenta accreta considered life-threatening?
It can cause massive hemorrhage during delivery, leading to maternal shock and death.
Which combination of risk factors gives the highest chance of placenta accreta?
Placenta previa + multiple prior cesarean deliveries.
Why is prenatal diagnosis important for placenta accreta outcomes?
It allows for planned delivery, surgical preparation, and reduces maternal/fetal morbidity and mortality.
Why is blood transfusion often required for patients with placenta accreta?
Because delivery can cause massive, rapid blood loss that the body cannot compensate for on its own.
Why is immediate postpartum hysterectomy often recommended instead of attempting to remove the placenta?
Attempting removal can cause catastrophic hemorrhage since the placenta is deeply embedded.