Placenta percreta

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 serosal breach. It carries severe maternal as well as fetal risks.

It represents ~20% of all types of abnormal villous adherence. The incidence is thought to be increasing presumably due to the increased practice of caesarean sections (which is a risk factor).

It is characterised by transmural extension of placental tissue across the myometrium with 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

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

Surgical intervention is a mainstay of treatment in most cases. However bleeding during intervention is a serious concern especially in a situation where adjacent organs such as bladder or bowel in involved. In these circumstances, conservative management is preferred. Embolisation techniques have also been considered in selected cases.

Complications

Ultrasound - obstetric
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Article Information

rID: 13496
System: Obstetrics
Section: Pathology
Synonyms or Alternate Spellings:

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    Figure 1: diagram - placenta percreta
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