Placenta percreta
Citation, DOI & article data
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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Epidemiology
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).
Risk factors
- prior cesarean section
- placenta previa
- advanced maternal age
- uterine anomalies
- intrauterine adhesion bands
- previous surgery
Pathology
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.
Radiographic features
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
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.
Complications
- uterine rupture
- catastrophic peripartum hemorrhage
References
- 1. Maldjian C, Adam R, Pelosi M et-al. MRI appearance of placenta percreta and placenta accreta. Magn Reson Imaging. 1999;17 (7): 965-71. Magn Reson Imaging (link) - Pubmed citation
- 2. Sonin A. Nonoperative treatment of placenta percreta: value of MR imaging. AJR Am J Roentgenol. 2001;177 (6): 1301-3. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Neish AS, Frates MC, Tempany CM. Placenta percreta post evacuation: an unusual uterine mass on MRI. J Comput Assist Tomogr. 19 (5): 824-7. - Pubmed citation
- 4. O'brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am. J. Obstet. Gynecol. 1996;175 (6): 1632-8. Am. J. Obstet. Gynecol. (link) - Pubmed citation
- 5. Hudon L, Belfort MA, Broome DR. Diagnosis and management of placenta percreta: a review. Obstet Gynecol Surv. 1998;53 (8): 509-17. Obstet Gynecol Surv (link) - Pubmed citation
- 6. Barber JT, Tressler TB, Willis GS et-al. Arteriovenous malformation identification after conservative management of placenta percreta with uterine artery embolization and adjunctive therapy. 2011;doi:10.1016/j.ajog.2011.01.001 - Pubmed citation
- 7. O'Brien W, O'brien WT, Sr. Top 3 Differentials in Radiology, A Case Review. Thieme Medical Pub. (2009) ISBN:1604062266. Read it at Google Books - Find it at Amazon
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