Placenta Accreta

Rose May Formoso

BSN 2
I. Descriptions

The placenta is a fascinating organ that is critical for human development. It function as
the maternal-fetal interface and performs the roles of the lungs, liver, and kidneys for the
growing gestation, as well as providing nutrition. Umbilical cord makes stable interconnection
between fetal well-being and placenta at the fetomaternal interface level. Both the placenta and
cord is essential for the fetus development however, these two could have abnormalities and can
lead to unwanted effects.

Placenta Accreta
A serious pregnancy condition that occurs when the placenta grows too deeply into the
uterine wall. Typically, the placenta detaches from the uterine wall after childbirth. With
placenta accreta, part or the entire placenta remains attached. This often leads to two major
complications, the placenta cannot normally deliver after the baby’s birth, and attempts to
remove the placenta can lead to heavy bleeding. It has a frequency of 1 per 2,500 deliveries.
Largely, it became a result of the increase in the number of cesarean section.

Degrees of severity

1. Accreta Vera​. In which the placenta adheres to the myometrium without invasion into the
muscle.
2. Increta​, in which it invades into the myometrium.
3. Percreta​, in which it invades the full thickness of the uterine wall and possibly other
pelvic structures, most frequently the bladder.

II. Cause/s

Placenta accreta is thought to be related to abnormalities in the lining of the uterus,

typically due to scarring after a C-section or other uterine surgery. Sometimes, however, placenta
accreta occurs without a history of uterine surgery.

III. Risk Factors

Previous uterine surgery (C-section, myomectomy)

Asherman’s syndrome
Previous placenta previa
Uterine leiomyoma
Maternal age greater than 35.

The risk of maternal and fetal complications increases notably after 35​th week exceeding
90% after 36​th week associated with the degree of invasion. Placenta previa itself raises the risk
for accreta due to implantation over highly vascular, poorly contractile lower uterine segment.
IV. Signs & Symptoms

Placenta accreta often causes no signs or symptoms during pregnancy although vaginal
bleeding during the third trimester might occur. Extreme cases of placenta accreta, in which
placenta begins to invade the bladder or nearby structures can present with bladder or pelvic pain
or occasionally with blood in the urine.

V. Schematic Pathophysiology

VI. Diagnostic Examinations/Procedures

Gray-scale sonography – tells if there is a loss or progressive thinning of the retro

placental hypoechoic zone, presence of multiple placental lakes and thinning of the
uterine serosa-bladder wall complex. Also evaluates the tissue beyond uterine serosa.
Transvaginal sonography ​– evaluate a patient suspecting of having placenta previa. The
use of transvaginal probe to evaluate the sagittal plane of the cervix.
Color Doppler ​– tells if there is dilated vascular channels with diffuse lacunar flow, or
hyper vascularity.
Magnetic Resonance Imaging ​– use if ultrasound is not conclusive, particularly in the
differentiation between accreta and percreta because it provides precise anatomic images.
VIII. Therapeutic Management

Surgery is the most common and effective treatment for accreta. After the birth of the
baby, this usually involves either the surgical removal of the placenta or a hysterectomy
to remove the uterus along with the accreta. The ovaries are usually left in place if a
hysterectomy is performed. This will prevent the mother from going into menopause.
B-Lynch suture – if bimanual compression decreases the amount of uterine bleeding.
Uterine Artery Ligation or Hypogastric Artery Ligation
Uterine packing or Foley catheter – use of condom to control massive hemorrhage.

XI. Nursing Interventions

Assess vaginal bleeding

Place patient in the frog-leg position (if patient do not respond to oxytocin or
ergometrine).
Assess maternal and fetal vital signs.
Administer medication as prescribed.
Provide emotional support to couple labor.
Prepare patient for cesarean delivery.

X. References

● https://www.slideshare.net/mobile/paviarun/placenta-accreta-144539798
● Slide share of Mr. Mohammed Abdallah