Aditiawarman
Depart /SMF Obstetri Ginekologi
FK Unair/RSUD Dr Sutomo
Surabaya
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Incidence
Retained placentas affect 0.5 3% of
women following delivery
The incidence of placenta accreta
increased ten-fold in the past 50 years
and is now encountered in 1 in 2500
pregnancies
A blood transfusion rate 70% is
needed following diagnosis of
placenta accreta
Risk factors
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Pathology
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The pathophysiology
Classification
According to the degree to which the
myometrium is penetrated by
placental villi.
In placenta accreta vera, placental villi
embed directly onto myometrium in the
absence of decidua;
In placenta increta, placental villi are
found deeper into the myometrium
In placenta percreta, the villi have
penetrated through the uterine serosa
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How to diagnose
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Screening
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Second trimester
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Sensitivity: 53.5%,
Specificity: 88.0%
Positive predictive value: 82.1%
Negative predictive: 64.8%
Accuracy: 64.8%,
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Lacunae
The lacunae give a moth-eaten appearance
to the placenta and usually, but not always,
have turbulent flow within them.
Appear irregular, often more linear rather
than rounded and smooth bordered.
They do not have the highly echogenic
border that standard venous sinuses have.
Tornado-shaped flow of venous, arterial or
mixed blood is typical
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Lacunae
Bladder border
The border between the bladder and
myometrium is normally highly
echogenic and smooth
In the case of placenta accreta,
interruptions or bulging can occur
this is a specific sign, but not a
sensitive one, i.e. interruptions or
bulging are not present in every
patient with placenta accreta
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Budging
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Myometrial thickness
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Color flow
Bridging/crossing vessels
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MRI
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Resume
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