Pregnancy

Placenta accreta, increta, percreta: what are they?

Placenta accreta is a serious complication of pregnancy, which occurs when the placenta grows too deeply into the uterine wall.

Based on the depth of invasion of the myometrium (muscle tissue of the uterus) by the chorionic villi, according to the ACOG classification , the following are distinguished:

  • placenta accreta (PA) : chorionic villi adhere to the myometrium but do not invade the muscle
  • placenta increta : chorionic villi partially invade the myometrium
  • placenta percreta : the chorionic villi invade the entire myometrium up to the serosa, sometimes also involving nearby organs (bladder)

Typically, the placenta detaches from the uterine wall after delivery (afterbirth ) . With these placental abnormalities, part or all of the placenta remains attached. This can cause major bleeding after delivery.

If the condition is diagnosed during pregnancy, an early cesarean delivery followed by surgical removal of the uterus (hysterectomy) is likely needed.

PA is thought to be related to abnormalities affecting the lining of the uterus, such as scarring following a cesarean section or other uterine surgery. Such an anomaly could occur even without a previous history of uterine surgery.

Women should be informed of the fact that the indiscriminate and unjustified use of caesarean section ( Italy is among the first places in the world for number of caesarean deliveries ) exposes the patient to further subsequent caesareans and to an exponential increase of this serious obstetrical complication.

Symptoms

Placenta accreta often causes no particular symptoms during pregnancy, although vaginal bleeding may occur during the third trimester.

It is important to be able to promptly diagnose PA and prevent its complications before the third trimester of pregnancy, avoiding recognizing it late at the time of delivery.

Ultrasounds (2D associated with Dolor Doppler and 3D) are essential to diagnose it.

It is no longer a rare complication

PA was a rare disease between the 1930s and 1950s, with a frequency of about 1 case every 30,000 deliveries. Its frequency increased to 1 case for every 19,000 deliveries between the 1950s and 1960s.

Between 1994 and 2002 there was an incidence of PA of 1 case in 2000-2500 births. Very high numbers that show no signs of decreasing and which have settled on about 2 parts every 1000. 

This increase in the incidence of PA goes hand in hand with the increase in the need for cesarean deliveries.

Risk factors

There are a few factors that can increase your risk of placenta accreta, including:

  • Previous uterine surgery . Your risk increases with the number of cesarean sections or other uterine surgeries you’ve had.
  • Location of the placenta : Risk increases if the placenta partially or fully covers the cervix ( placenta previa ) or is in the lower part of the uterus
  • Maternal age: It is more common in women over the age of 35.
  • Previous deliveries : The risk of placenta accreta increases with the number of pregnancies you have
  • Submucosal fibroids

In the absence of the previous risk factors, the probability of having PA is 1 case for every 22,000 deliveries.

Complications

  • Placenta accreta can cause severe bleeding after delivery that can lead to blood transfusions.
  • Placenta accreta may cause labor to start before it is due. In addition, bleeding during pregnancy may make it necessary to deliver the baby early.

Typically if a patient is diagnosed with placenta accreta, a planned cesarean delivery with hysterectomy (removal of the uterus) is done around the 34th week of pregnancy.

In some cases (when placenta accreta is focal, fundic, or posterior ), salvage of the uterus may be attempted unless there is, or is at risk of, severe hemorrhage.

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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