169
Charleen Sze-Yan Cheung, MBBS(HK), MRCOG, FHKAM(O&G); Ben Chong-Pun Chan, MBBS(HK), FRCOG, FHKAM(O&G), FHKCOG, Cert RCOG (Maternal and Fetal Med)
INTRODUCTION
Morbidly adherent placenta involves
a spectrum of abnormal placental implantation. Placenta accreta occurs
when chorionic villi attach to the myometrium. Placenta increta refers to the
invasion of villi into the myometrium.
Placenta percreta is defined by invasion extending deep beyond the uterine serosa. It may also involve adjacent
organs, commonly the urinary bladder.
Placenta accreta and its associated
spectrum are often collectively described in the literature.1,2
Placenta accreta is associated with
substantial maternal risks, including
life-threatening obstetric haemorrhage,
dilution or consumptive coagulopathy,
massive
transfusion
and
reactions,
caesarean
caesarean hysterectomies.68 It is a
abnormal
adherence.
The
two
most
important
placental
section
rates
worldwide,
risk
5,1012
170
6588%.1,20,21
lucent
vascular
of
parenchyma
cases.3,5,9,22
While
retroplacental
DIAGNOSTIC APPROACH
placenta accreta.9,20,31,32
in a clinical setting.
Reliable
antenatal
diagnosis
zone,
presence
in
of
extreme
obliteration
of
OBSTETRIC MANAGEMENT
STRATEGIES
Antenatal Management
Ultrasonography
velocity
extending
otherwise.28
for
lateral view.
Application
flow
of
colour
(> 15 cm/s)
Doppler
26
27,28
accreta
has
been
171
anticipated,
prevent
it
anaemia
is
beneficial
to
and
optimize
the
antepartum
haemorrhage.
morbidity
associated
with
elective
late
preterm
assistance is required.9
delivery at term.9,28
Intrapartum Period
essential.
Adoption
versus
and
information
is
Involvement
of
the
of
conservative
preoperative
hysterectomy,
visceral
injuries.
Possible
sheet
and
communication
mencement of an operation.35
cystotomy,
ureteric
and
understanding,
Dorsal
lithotomy
positioning
172
the
upper
abdomen.
Careful
Figure 1. Thin and very vascular uterine lower segment at the time of caesarean section.
the rich vascularity usually correlates with the position of placentation
if necessary.
severe haemorrhage.5,35
have
devices,
peripheral
and
It
is
good
practice
to
hypothermia,
and
prophylaxis.
The
obstetric
to
individualized.
unnoticed.1
thromboembolic
Regional
5,36
anaesthesia
haemorrhage
is
likely
173
to
women
who
wish
aggressive
Conservative
surgical
approach.37
management
aims
to
stability
without
possibility
of
preoperative
Careful
selection
and
preoperative
methods
haemostatic
fibrin
square,
39
40
formation.
Substitutes
include
tamponade
resource-limited settings.42,43
placenta accreta.
balloon,
uterine
can
Foley
be
or
condom
considered
in
failure.1
haemorrhage.
measures
and
to
prevent
reduce
ongoing
uterine
flow
Balloon
tamponade
acts
174
coagulopathy.15
spectrum
cell
agents
Prophylactic
uterotonic
are
conservative
removal,
but
remains
undetermined.
could
theoretically
re-
are
and
recommended,
salvage
antibiotics
broad-
often
prerequisites
correlation
Hysteroscopic
Postpartum Period
35
the
to
clinical
of
patient
medical litigation.
CONCLUSION
methotrexate.
Methotrexate
is
dissatisfaction
and
risks
of
should
be
monitored
and
175
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