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What is Placenta Adherence-Acreta–Inccreta and Percreta–Management

Placenta Adherens - Placenta Acreta, Increta, and Percreta:retained placenta removal 2
In these conditions whole or part of the placenta is adherent to the uterine wall due to an invasion of myometrium with chorionic villi which make expulsion of placenta out of the uterus difficult.

Adherent Placenta or Placenta Adherens

Placenta adherens is a condition in which placenta remains attached to the uterine wall for an abnormally long time following birth.

Causes Of Adherent Placenta:

1. Uterine Contraction is necessary for placental separation. any deficiency or incoordination of uterine contraction may make placenta difficult to separate.
2. Uterine anomalies: An abnormally shaped uterus can prevent the placenta from being expelled.
3. Hormonal Causes: During childbirth, the hormone oxytocin is released into the blood. Oxytocin is a potent hormone which induces powerful uterine contraction which helps in placental separation as well. If for some reason, adrenaline is released into the blood (adrenaline is a hormone released into the blood during “fight or flight” response) oxytocin release can be inhibited and therefore prevent the uterus from contracting.

Management Of Placenta Adherens

Agents that help to amplify uterine contraction are administered via umbilical vein. As it is stated earlier that uterine contractions help in placental separation. Therefore, in most of the cases, placenta comes out of the uterus after administration of uterotonic agents. Currently, this is first-line therapy recommended by WHO (March 2012)
If placenta fails to come out after drug therapy, manual separation of placenta would be necessary.

Placenta Accreta:

In placenta accreta chorionic villi are in contact with the myometrium instead of being contained within the decidua.

Placenta Increta:

In placenta Increta there is an extensive invasion of chorionic villi into the myometrium. Which is a more severe condition than placenta acreta.

Placenta percreta:

In this condition, chorionic villous invasion extends to the serosal covering (that is the outer covering) of the uterus. This condition is the most severe among the three.

All these three conditions are usually found in those patients who have previous history of uterine surgery or caesarean section.

Management:

Hysterectomy is the procedure of choice if women have no intentions of bearing  further children.
Other measure include:
1. excision or scrapping of the site of trophoblastic invasion.
2. Uterine or internal artery ligation may be helpful.

See also:

1. Complications Of third Stage Of Labour:

2. Primary Post Partum Hemorrhage

3. Uterine Rupture and Scar Dehiscence

4. Uterine Inversion – Etiology, Management and Treatment.

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