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ABNORMAL ADHERENCE ABNORMAL ADHERENCE OF PLACENTAOF PLACENTA
Dr Uong SokhanDr Uong Sokhan
ObjectivesObjectives1. Identify the different types of 1. Identify the different types of
placenta accretaplacenta accreta2. List the etio-factors of placenta 2. List the etio-factors of placenta
accretaaccreta3. Describe the clinical course of 3. Describe the clinical course of
placenta accretaplacenta accreta
Certain placental abnomalities are Certain placental abnomalities are documented and are clinical documented and are clinical significance.significance.
Their knowledge is very important in Their knowledge is very important in managing during the antenatal managing during the antenatal period and the third stage of labor.period and the third stage of labor.
Normal implantation of placentaNormal implantation of placenta
Normal implantation of placentaNormal implantation of placenta
Normal implantation of placentaNormal implantation of placenta
Placenta accretaPlacenta accretaI. DefinitionI. Definition
Placenta which is abnormally firm Placenta which is abnormally firm adherence to the uterine walladherence to the uterine wall
Placenta accreta: placetal villi are Placenta accreta: placetal villi are attached to the myometriumattached to the myometrium
Placenta increta: placetal villi invade Placenta increta: placetal villi invade the myometriumthe myometrium
Placenta percreta: placetal villi Placenta percreta: placetal villi penetre through the myometrium penetre through the myometrium
A. Normal implantationA. Normal implantationB Placenta accretaB Placenta accretaC. Placenta incretaC. Placenta incretaD. Placenta PercretaD. Placenta Percreta
Placenta accreta Placenta accreta (continued)(continued)
Abnormal adherenceAbnormal adherence may involve: may involve:All of cotyledons All of cotyledons total placenta total placenta
accretaaccretaA few to several cotyledon A few to several cotyledon Partial Partial
placenta accretaplacenta accretaA single cotyledon A single cotyledon focal placenta focal placenta
accretaaccreta
Placenta accreta Placenta accreta (continued)(continued)
II. Etiological factorsII. Etiological factorsMost often in circumstances where Most often in circumstances where
decidual formation was likely to have decidual formation was likely to have been defectivebeen defective
Placental implantation in the lower Placental implantation in the lower uterine segment over a previous uterine segment over a previous cesarean section scar or others previous cesarean section scar or others previous uterine incisionuterine incision
Or occurrence after uterine curettageOr occurrence after uterine curettage
Placenta accreta Placenta accreta (continued)(continued)
III. Clinical courseIII. Clinical course1.1.Antepartum Antepartum
HemorrhageHemorrhage is common, consequence is common, consequence of of coexisting placenta previacoexisting placenta previa
2. During labour2. During labourMyometrial invasion by placental villi at Myometrial invasion by placental villi at the site of previous cesarean section the site of previous cesarean section may lead to may lead to uterine rupture during uterine rupture during labor labor or even beforeor even before
Placenta accreta Placenta accreta (continued)(continued)
3. 3. Problems associated with delivery of Problems associated with delivery of placentaplacenta and subsequent development and subsequent development vary appreciably depending upon:vary appreciably depending upon: site of implantation,site of implantation, depth of myometrial penetration,depth of myometrial penetration, and number of cotyledons involvedand number of cotyledons involved
It is very likely that focal placenta accreta It is very likely that focal placenta accreta with implantation in the upper uterine with implantation in the upper uterine segment is much more often developssegment is much more often develops
Placenta accreta Placenta accreta (continued)(continued)
a) a) AnAn involved cotyledoninvolved cotyledon is either is either - - pulled off pulled off the myometrium the myometrium
with with somewhat excessive bleedingsomewhat excessive bleeding, , oror
- - torn from the placenta torn from the placenta and and adheres to the implantation site with adheres to the implantation site with increase bleeding immediately or increase bleeding immediately or later later
Placenta accreta Placenta accreta (continued)(continued)
b) b) With more extensive involvement of cotyledons With more extensive involvement of cotyledons ::Hemorrhage becomes profuse Hemorrhage becomes profuse as delivery of as delivery of placenta is attempted,placenta is attempted,
Successful treatment depends upon immediate blood Successful treatment depends upon immediate blood replacement therapy and nearly always prompt replacement therapy and nearly always prompt hysterectomyhysterectomy
C) C) With total placenta accretaWith total placenta accreta there may be:there may be: Little or no bleedingLittle or no bleeding Traction may cause inversion of uterusTraction may cause inversion of uterus Usual attempts at manual removal will not succeedUsual attempts at manual removal will not succeed
Prompt hysterectomy is the safest treatmentPrompt hysterectomy is the safest treatment