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Placenta
accreta is an abnormally adherent placenta, resulting in delayed
delivery of the placenta.
Placenta accreta occurs because the villi penetrate the uterine myometrium. It can result in incomplete expulsion of the placenta, hemorrhage, and infection. Risk factors include Incidence in women who have had placenta previa and ≥ 2 cesarean deliveries is almost 40%.
Placenta accreta can sometimes be diagnosed before delivery by ultrasonography or MRI. Then, preparations for cesarean hysterectomy are made. During delivery, the disorder is suspected if the placenta has not been delivered within 30 min of the infant's delivery, if no plane of separation can be created with attempts at manual removal, or if placental traction causes large-volume hemorrhage. In such cases, laparotomy with preparation for large-volume hemorrhage is required. Hysterectomy is the safest procedure, but if keeping the uterus is important and hemorrhage is not massive, sometimes hysterectomy can be avoided by resection of the abnormal site (primarily when accreta is focal). Methotrexate therapy after the placenta is left in situ has also been attempted in stable patients.
Last full review/revision December 2008 by Julie S. Moldenhauer, MD
Content last modified December 2008
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