Placenta accreta

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Placenta accreta

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High Yield Notes

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NOTES NOTES DISORDERS OF LABOR PLACENTA ACCRETA osms.it/placenta-accreta PATHOLOGY & CAUSES SIGNS & SYMPTOMS ▪ A type of abnormally developed, invasive placenta ▫ Normally a spontaneous, complete placenta separation from uterine wall (myometrium) ▫ Maternal placenta side (decidua) separates from myometrium at stratum basalis layer ▪ Absent/underdeveloped decidua occurs in placenta accreta → adherence of fetal chorionic villi directly to myometrium → placenta fails to fully separate after fetus is delivered ▫ Partial separation → profuse hemorrhage → hemorrhagic shock and coagulopathy ▫ If no separation → hemorrhage is induced when manual separation is attempted ▪ Placenta fails to spontaneously deliver after fetus’s birth ▫ Manual separation attempts unsuccessful, provoke increased bleeding ▪ Severe hemorrhage ▪ Boggy (soft, spongy) uterus unresponsive to uterotonics/uterine massage TYPES DIAGNOSTIC IMAGING ▪ Placenta accreta; placenta increta; placenta percreta (based on invasiveness) ▪ Placenta accreta also increases risk of preterm bleeding ▫ Association between placenta accreta, concurrent placenta previa RISK FACTORS ▪ Previous uterine surgery ▫ Cesarean section (most common), myomectomy, curettage ▫ Scar tissue prevents normal placental implantation ▪ Previous placenta previa 732 OSMOSIS.ORG DIAGNOSIS ▪ Based on clinical presentation of hemorrhage post-delivery; severe hemorrhage after attempted manual placenta delivery ▪ Prenatal diagnosis allows planned management (e.g. cesarean birth, cesarean hysterectomy) Ultrasound, color Doppler ▪ Evaluate alterations in intraplacental blood ﬂow, status of placental-myometrial interface LAB RESULTS ▪ Laboratory tests may show ↑ maternal serum alpha fetoprotein

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Placenta accreta

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A 33-year-old woman, gravida 3 para 2, is admitted to the labor and delivery unit with active contractions every 3-5 minutes. Her previous births were via cesarean sections. One hour later, she gives birth to a healthy child. Thirty minutes after delivery, the placenta has still not been delivered. Manual extraction of the retained placenta is performed and leads to profuse bleeding. The patient’s temperature is 37.0°C (98.6°F), pulse is 120/min, and blood pressure is 85/60 mmHg. Oxygen saturation is 95% on room air. On physical examination, the uterus is firm and nontender. Hemoglobin is 9 g/dL and platelet count is 220,000/mm3. Which of the following is the most likely underlying mechanism for this patient’s bleeding?

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