Placenta Accreta Increta and Percreta

These three conditions are forms of abnormal placental attachment in which the trophoblasts invade beyond the normal location into the uterine muscle to varying degrees. Abnormal blood supply to the inner lining of the uterus and prior trauma to both the endometrium and myometrium (the muscle layer) appear to alter lower uterine physiology and influence placental implantation. The most common risk factor is a previous cesarean delivery or prior uterine surgery.

The risk of maternal death is 3%. In cases of bladder involvement with a placenta percreta, the risk of maternal death increases to 20%. The leading immediate causes of death are uterine bleeding and DIC. Placenta accreta, increta, or percreta is often the etiology of retained placenta (Breen et al., 1997). During manual extraction, the placenta fragments without complete separation, resulting in uncontrolled hemorrhage.

The major factor affecting outcome is the degree of placental invasion. A minimally invasive placenta (accreta) can often be removed manually or by curettage. Invasion deeper in the myometrium (increta) or through the myometrium (percreta) more often requires hysterectomy. The increased rate of cesarean deliveries is making abnormalities of placental attachment more frequent, particularly if the placenta is attached in the area of the prior uterine incision.

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