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Placenta Accreta – a Case Report

Maneesha De, Simona Angel, Kremen Tsvetkov, Emil Kovachev, Atanas Alexandrov

Abstract

Introduction: Placenta accreta is a condition of abnormal placentation and invasion of chorionic villi deep into the uterine wall layers. It represents a life threatening obstetrical emergency leading to severe postpartal hemorrhage. Women at greatest risk are those who have myometrial damage caused by previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar.  With the increasing rates of Cesarean section and maternal age the incidence of this condition is also rising – from 1 in 4000 pregnancies in 1970s to 1 in 210 in 2006. The advances in modern ultrasonography are giving the ability to reach the diagnosis antenatally and to prevent a severe morbidity and mortality.

Material and Methods: Most commonly (88%) placenta accreta is associated with placenta previa. This poster is presenting an unusual case of placenta accreta attached to the uterine fundus.

Result: The pregnancy ended with a normal delivery of a healthy infant. Instrumental revision under ultrasound was performed and finally a subtotal hysterectomy had to be conducted. In order to avoid an emergency cesarean and to minimize the complications of prematurity it is acceptable to schedule an operative delivery at 34-35 weeks of gestation. A multidisciplinary team of experienced physicians is required to secure the best outcomes for both the fetus and the mother. In the recent years new techniques are approaching in order to save the uterus although unconvincing results with these new conservative methods are lacking. The preferable management of placenta accreta remains a Cesarean hysterectomy leaving the placenta in situ.

Conclusion: This case study showed that consistent review, observation and imaging is important to diagnose and adapt treatment methods in order to provide the best care possible during pregnancy.


Keywords

placenta accreta


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