Placenta Accreta: Case Report From Ultrasound diagnosis to Treatment
Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2018, Vol 1, Issue 5
Abstract
Placenta accreta is the most common variant and is defined as trophoblastic attachment to the myometrium without intervening decidua [1]; placenta percretais the most serious variant because placenta invades the uterine serosa. All varieties are associated with a significant increase in maternal morbidity and mortality, mainly due to bloodloss, local organ damage, urgent hysterectomy (33-50%) and postoperative complications [2,3]. Placenta previa and previous uterine surgery are the major risk factors for invasive placentation [4,5]. Placenta previa is defined as a placenta that either lies in closeproximity to the internal cervicalos or partially or completelycoversit [1]. Placenta previa and accreta and theircomplications are increasing due to a higher number of Cesarean sections being performed and advanced maternal age [1-6]. Although placenta previa isper se a risk factor, the most common is a uterine scar. The risk increases from 0.3% after one prior Cesarean section to 0.6, 2.1, 2.3 and 6.7% after two, three, four and more than four Cesarean sections, respectively [7]. The principal maternal complication is massive hemorrhage, that then leads to disseminatedintravascular coagulation, multi organ failure ad even death; Wright et al estimated a median bloodloss in cohorts of accretas from 2.000 to 7800 ml [8]. Peripartum hysterectomy rates is 30-55% [9] and maternal death has been reported in 5-7% of cases [10]. As there are reports in the literature that maternal complications, such as peripartum blood loss andneed for blood transfusion, are reducedwhenthe delivery isarranged in a centre of execellence, an accurate antenatal diagnosis of invasive placentation is important [9,11,12]. Further more prenatal diagnosis allows for optimal management, which typically includes planned cesarean hysterectomu before the onset of labor or bleedig [10]. In referred center a case of placenta accreta is managed by a multidisciplinary team that includes specialists in maternal-fetal medicine, obstetric ultrasound, gynecologic surgery and oncology, urologic surgery trasfusion medicine, intensive care, neonatology and anesthesioloy. It’simportant to refercases of placenta accreta to a centre of excellencealso for the diagnosis: in factultrasoundsensitivity in the second-thirdtrimester of pregnancy for the identification of placenta accreta with expertsoperators and in case of anterior placenta previaisreported to be 80-90% [10,3,13]. Ultrasound criteria suggesting placenta accreta spectrum are: lossor irregularity of the hypoechoic area between theuterus and placenta (the ‘retroplacentalclear zone’),thinning or interruption of the uterineserosa-bladder wall interface,myometrial thickness<1mm,turbulent placental lacunae with high velocity flow (>15 cm/s), increased and irregular subplacental vascularity, vessels between placenta and bladder [13-15]. The optimal timing of delivery for placenta accretas and its variants remains controversials: the risks of prematurity must be balanced against the risk of emergency delivery in the setting of labor or bleeding.
Authors and Affiliations
E Pilloni, A Sciarrone, P Cortese, C Monzeglio, M Biasio, G Botta e G A Gregori
Keywords
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- EP ID EP571507
- DOI 10.32474/IGWHC.2018.01.000124
- Views 76
- Downloads 0
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