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Placenta percreta is a term given to the most severe but least common form of the spectrum of abnormal placental villous adherence, where there is a transmural extension of placental tissue across the myometrium with a serosal breach. It carries severe maternal as well as fetal risks.
The milder end of the spectrum of abnormal placental villi adherence are:
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It represents ~5% of all types of abnormal villous adherence. The incidence is thought to be increasing, probably due to the increasing practice of cesarean sections (which is a risk factor).
- prior cesarean section
- placenta previa
- advanced maternal age
- uterine anomalies
- intrauterine adhesion bands
- previous surgery
It is characterized by transmural extension of placental tissue across the myometrium with a serosal breach. Placental invasion of the myometrium is related to a thinned decidual endometrium at the site of implantation and this can happen for a number of reasons.
Ultrasound may identify:
- protrusion of placental tissue beyond the outer confines of the uterine myometrium
- increased vascularity between serosa and adjacent structures such as the bladder
Treatment and prognosis
Surgical intervention is a mainstay of treatment in most cases. However, bleeding during the intervention is a serious concern especially in a situation where adjacent organs such as bladder or bowel are involved. In these circumstances, conservative management is preferred. Embolization techniques have also been used in selected cases.
- uterine rupture
- catastrophic peripartum hemorrhage
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