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Placental accreta or placenta accreta is an abnormal insertion of the placenta into the wall of the uterus, that is, when the placenta adheres too much to the wall of the uterus, during pregnancy. Its severity will vary depending on whether the placenta penetrates only one layer of the uterus (placenta accreta), the three layers of the uterus (increta) or crosses it (percreta). But how does this placental problem affect the pregnant woman?
Maternal and fetal morbidity and mortality can be affected by this type of pathology, which usually appears in the last of the three phases of labor: delivery, when the mother already has her baby in her arms and only the expulsion of the placenta.
Usually this occurs within 20 minutes after the baby is bornIn order to facilitate this event and prevent maternal bleeding after delivery, and in most hospitals, what we call targeted delivery is performed. We suspect that there is some degree of accreta when the placenta does not detach in a reasonable time or when after delivery, a cotyledon is missing in the revision of the placenta.
During pregnancy, placental accreta is normally asymptomatic; it is at delivery that the main complication associated with this phenomenon occurs: maternal hemorrhage.
Which are the risk factors?:
- Placenta seated in a uterine scar, with previous cesarean section being the main cause. The risk increases with the number of caesarean sections.
- Previous placenta
- Previous uterine scar, due to any surgical intervention
- Other factors: age over 35 years, multiple, endometrial fibroids, tobacco ...
The diagnosis prior to delivery will determine a better management of the situation. The preferable method is vaginal ultrasound, by which the gynecologist assesses the normality of the placenta, its insertion .... In those cases in which the ultrasound is not conclusive, an MRI is performed.
What is the prognosis and treatment? If there is a diagnosis is accreta before delivery, a cesarean section is usually scheduled, in order to reduce bleeding. Although the decision must be individualized, taking into account the peculiarities of each woman and her baby.
Definitive treatment for placenta accreta is hysterectomy after cesarean section, especially in women who do not want to have more children, or when bleeding cannot be managed with other means: uterine artery embolization, drugs, mechanical procedures (placement of a balloon that compresses the bleeding bed).
If after delivery, placental accreta is suspected because delivery does not occur, and the woman wishes to have more children, maneuvers are performed to preserve the uterus, such as manual removal of the placenta.
In recent years, conservative treatment is being considered, in such a way that the placenta would be left 'in situ', in order to preserve the uterus and neighboring organs, in the event of penetration and involvement of other organs. And it is considered in those patients who consider preserving their fertility.
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