Placenta Accreta

GROUP 7
 Question 1
It is an abnormal adherence of placenta to uterine wall due to
abnormality of decidual basalis layer in uterus placental villi
attach to myometrium.

a. Placenta Previa
b. Placenta Accreta
c. Placenta Increta
d. Marginal Previa
ANSWER: B. Placenta Accreta

RATIONALE:

a. Placenta previa is problem during pregnancy when the placenta

completely or partially covers the opening of the uterus
(cervix).
b. Placenta accreta is an abnormally deep attachment of the
placenta to uterine wall through endometrium into the
myometrium
c. Placenta increta is a further extension of placenta into
myometrium deeper into muscle.
d. Marginal previa is a type of placenta previa wherein the
placenta is positioned at the edge of your cervix.
 Question 2
A patient is diagnosed with placenta accreta. What would
be the primary management for her situation?

a. Hysterectomy
b. Vasectomy
c. None of the above
d. Both a and b
ANSWER: A. Hysterectomy

RATIONALE:

a. Hysterectomy helps prevent the potentially life-threatening

blood loss that can occur if there's an attempt to separate the
placenta.
b. Vasectomy (male sterilisation) is a surgical procedure to cut
or seal the tubes that carry a man's sperm to permanently
prevent pregnancy.
 QUESTION 3
A 24 years old client has been diagnosed with placenta
accreta . Which of the following factors is considered a risk
factor for placenta accreta?

a. Low-lying placentation (placenta previa)

b. Curettage, prior myomectomy
c. Prior cesarean delivery or uterine
d. All of the above.
ANSWER: D. All of the above

RATIONALE:

Low-lying placentation (placenta previa, Curettage, prior

myomectomy and prior cesarean delivery or uterine are all risk
factors of placenta accreta.
 QUESTION 4
A 26 year old female patient has normal delivery followed by
failure to deliver placenta for greater than 30 minutes. What
will be the diagnosis?

a. RH Incompatibility
b. Placenta accreta
c. Pre-eclampsia
d. Abruptio placenta
ANSWER: B. Placenta Accreta

RATIONALE:

Placenta accreta is an abnormally adherent placenta,

resulting in delayed delivery of the placenta. Usually, vaginal
bleeding is profuse during manual separation of the placenta
after delivery of the fetus. However, bleeding may be minimal
or absent, but the placenta may not be delivered within 30
minutes after delivery of the fetus.
 Question 5
A 35-year-old woman, who is in labor has been diagnosed
with placenta accreta, which of the following risks could
be the reason?

a. Have a Placenta Previa

b. Have had a previous cesarean section
c. Have had multiple past pregnancies
d. All of the Above
ANSWER: D. All of the Above

RATIONALE

When the placenta blocks your cervix, it is called placenta previa.

The risk of placenta accreta increases with the number of C-
section births a person with placenta previa has had in the past.
Multiple C-section patients are more likely to develop placenta
accreta. This happens as a result of the operations scarring your
uterus.
 QUESTION 6
A 33 years pregnant woman has placenta previa, a risk
factor for placenta accreta. What diagnostic test should the
health care provider use to carefully examine the
implantation of your baby's placenta?

a. Biopsy
b. CBC
c. Both a and b
d. Ultrasound or MRI
ANSWER: D. Ultrasound or MRI

RATIONALE:
If you have risk factors for placenta accreta during pregnancy such
as the placenta partially or totally covering the cervix (placenta
previa) or a previous uterine surgery.

Through an ultrasound or MRI, the health care provider can evaluate

how deeply the placenta is implanted in your uterine wall.

Biopsy is a procedure to remove a piece of tissue or a sample of

cells from your body

CBC is a test that counts the cells that make up your blood: red
blood cells, white blood cells, and platelets.
 QUESTION 7
A 37 year old woman has been diagnosed with placenta
accreta is having a heavy vaginal bleeding. What procedure
should do?

a. CBC
b. Blood Smear
c. Blood transfusion
d. All of the above
ANSWER: C. Blood transfusion

RATIONALE:

Placenta accreta can cause serious complications. These

include severe vaginal bleeding, which may require a blood
transfusion.

CBC is a test that counts the cells that make up your blood:
red blood cells, white blood cells, and platelets.

Blood smear is a blood test that gives information about the

number and shape of blood cells
 Question 8
Which of the following factors related to maternal age is
considered a risk factor for placenta accreta?

a. A 37 years old women who has a previous uterine

surgery
b. A 25 years old women who has previous
appendectomy
c. A 37 years old men who undergo chemotherapy
d. Both a and b are the correct answers.
ANSWER: A. A 37 year old woman who has a previous
uterine surgery

RATIONALE:

Many factors can increase the risk of placenta accreta

including their maternal age which is more common in
women older than 35 and their previous uterine surgery
which increases risk with the number of C-sections or other
uterine surgeries the patient had. Previous appendectomy
has no relation to placenta accreta. Placenta accreta only
occurs in women.
 Question 9
A 37 year old client has been diagnosed with placenta
accreta . Which are the following complications can
possibly occur?

a. Severe vaginal bleeding (hemorrhage)

b. Umbilical cord wrapped around baby neck
c. Premature birth
d. Both a and c are the correct answers.
ANSWER: A. Both a and c are the correct answers

RATIONALE:

Placenta accreta poses a major risk of severe vaginal

bleeding after delivery. The bleeding can cause life
threatening condition that prevents the blood from clotting
normally as well as lung failure distress and kidney failure.
Placenta accreta does not directly harm the fetus. However,
it might cause labor begin early (premature birth), if it causes
bleeding during the pregnancy.
 Question 10
As a nurse you are aware that before the placenta functions,
the corpus luteum is the primary source for synthesis of which
of the following hormones?

a. Cortisol and thyroxine

b. Estrogen and progesterone
c. LH and FSH
d. T4 and T3
ANSWER: B. Estrogen and progesterone

RATIONALE:

The CL produces progesterone and estrogen for the 1st 8-10 weeks
of pregnancy until the placenta takes over this function. The high
levels of estrogen and progesterone cause suppression of LH and
FSH. 4 and T3 are produced in the adrenal gland.
 Question 11
A 33-year-old woman, no pathological antecedents (G2P2), one
living child, with previous caesarean section for acute fetal
distress. For the second pregnancy, antenatal period was not
followed until her presentation at 34 weeks of gestation in the
obstetric emergency for moderate bleeding per vaginum. The a
nurse should know that placenta accreta are most commonly
occurs in women who have had:

a. Abruptio Placenta
b. Placenta Previa
c. Ultrasonography
d. Premature birth
ANSWER: B. Placenta Previa

RATIONALE:

In women who have placenta previa, the risk of placenta accreta

increases from about 10% if they have had one cesarean delivery to >
60% if they have had > 4 cesarean deliveries. For women without
placenta previa, having had a previous cesarean delivery increases
risk very slightly (< 1% for up to 4 cesarean deliveries).
 Question 12
Which of the following is the most common kind of
placental adherence seen in 38 years old pregnant
women via IVF and had a history of uterine fibroid
removed?

a. Placenta Accreta
b. Placenta Previa
c. Placenta Percreta
d. Placenta Increta
ANSWER: A. Placenta Accreta

RATIONALE:

Placenta accreta is the most common kind of placental

adherence seen in pregnant women via IVF.
 Question 13
The nurse in the operating room is preparing for an
emergency dilation and curettage post vaginal delivery for
placenta accreta. What information is most important
when reviewing this client's chart?

a. Client has been NPO and has no metal on the body

b. Client has stable vital signs and has signed consent
c. Client has type and crossmatch on file and at least 2
patent large-bore IV sites
d. Client is on oxygen and has a patent IV site
ANSWER: C. Client has type and crossmatch on file and at
least 2 patent large-bore IV sites

RATIONALE:

These clients should have a type and crossmatch on the chart

in case an immediate blood transfusion is needed. They also
require an IV site in addition to the one used for anesthesia in
case a blood transfusion is necessary. Transfusion requires a
large-bore IV site (18-gauge preferred) that is patent.
 Question 14
Mrs. Sario is a 35 years old who experienced
abnormalities in her uterus lining that cause placenta
accreta. What are the risk factor that causes placenta
accreta?

a. Dropping of blood pressure

b. Menopausal stage
c. Hormonal imbalance
d. Placenta previa
ANSWER: D. Placenta Previa

RATIONALE:

One of the risk factor of placenta accreta is Placenta previa

which This condition occurs when the placenta blocks your
cervix. In people with placenta previa and a history of prior C-
section deliveries, the risk for placenta accreta increases with
the number of C-sections they’ve had.
 Question 15
A patient was refer for hysterectomy which is a procedure
of removal of the uterus. The patient asked you if she will
still get pregnant and as a nurse how will you explain to the
patient?

a. “Sorry it's not my job to answer that question go to a

doctor and ask them”
b. “Congratulations ma’am! You will still be pregnant”
c. “I’m sad to say but hysterectomy is the removal of
uterus and there is no chance of you getting pregnant”
d. “Don't worry you can adopt, that's no big deal”
ANSWER: C. “I’m sad to say but hysterectomy is the
removal of uterus and there is no chance of you getting
pregnant”

RATIONALE:

It is not possible to carry a pregnancy after a hysterectomy,

why? Because the uterus, also described as the womb, is
where a baby grows during pregnancy. Removal of the
uterus means no longer have periods and cannot get
pregnant.
 Question 16
Patient W is on post operative care from hysterectomy,
Nurse L understands that she may have ______
prescribed for any pain and discomfort that patient
may feel.

a. Narcotic Analgesics
b. Anticholinergics
c. Bronchodilators
d. Antihistamine
ANSWER: A. Pain Relief Medications

RATIONALE:

After surgery, discomfort and mild to moderate pain are

common. Take your pain medication before the pain
becomes severe. This will give you better pain control.
Anticholinergic drugs inhibit the transmission of
parasympathetic nerve impulses, Bronchodilators
medications used to dilate the lungs' airways, Antihistamine
are medicines often used to relieve symptoms of allergies
 Question 17
What are the primary complications of placenta accreta?
Select all that apply.

a) Maternal hemorrhage
b) Insomnia
c) Failure of the placenta to separate following birth of
the infant
d) Autonomic dysreflexia
e) Shoulder dystocia
ANSWER: A, C

RATIONALE:

a) The primary complications of placenta accreta are maternal

hemorrhage and failure of the placenta to separate following
birth of the infant.

c) The primary complications of placenta accreta are maternal

hemorrhage and failure of the placenta to separate following
birth of the infant.
 Question 18
Which of the following options best describes what
happens when the placenta is too closely attached to
the myometrium rather than the decidua basalis?

a. Decidua Basalis is not thick enough.

b. Trophoblast attached to the decidua basalis.
c. a and b
d. None of the above
ANSWER: A. Decidua Basalis is not thick enough.

RATIONALE:

The placenta is too firmly attached to the uterus. So, instead of

connecting to the decidua basalis or only to the decidua
basalis, the placenta connects too deeply to the myometrium,
which is frequently due to a defective decidua basalis, which is
not thick enough. Furthermore, trophoblast requires more to
hold onto, so they must dig deeper into the myometrium.
 Question 19
The following are medications. Which medication is used
for managing pain for post hysterectomy?

a. Morphine
b. Rivaroxaban
c. Aspirin
d. Doxycycline
ANSWER: A. Morphine

RATIONALE:

Your surgeon may prescribe 3 kinds of medicine to manage

your pain. pain pills called opioids. Examples include morphine,
hydromorphone (Dilaudid), oxycodone and Percocet. Opioids
can help reduce pain within 30 to 60 minutes and last for up to
6 hours. Rivaroxaban is an anticoagulant medication used to
treat and prevent blood clots, Aspirin is a nonsteroidal anti-
inflammatory drug used to reduce pain, fever, and/or
inflammation, and as an antithrombotic, Doxycycline is an
antibiotic used in the treatment of infections caused by bacteria
and certain parasites
 Question 20
When does Placenta Accreta usually occur during
pregnancy?

a. First trimester
b. Second trimester
c. Third trimester
d. Before pregnancy
ANSWER: C. Third trimester

RATIONALE:

Placenta Accreta usually occur between 34 and 37 weeks

gestation (3-6 weeks early), depending on the severity of the
accreta.