Placental Disorders

what is the definition for placental accreta, increta and percreta

blood vessels and other parts of the placenta grow too deeply into the uterine wall

what are placental accreta, increta and percreta associated with

low-lying placenta, uterine trauma from earlier c/s

what is required to determine whether a woman has accreta, increta or percreta

specialised imaging with a colour doppler, and MRI

what is the prevalence of accreta (out of accreta, increta and percreta)

84%

what is the prevalence of increta (out of accreta, increta and percreta)

13%

what is the prevalence of percreta (out of accreta, increta and percreta)

3%

the placenta accreta spectrum is the generalised term applied to what

abnormal adherence of the placental trophoblasts to the uterine myometrium

what is placental previa

placental implantation at the bottom of the uterus - over the cervix or close to the cervix

what is the prognosis and treatment for accreta/increta/percreta

planned elective c/s at 36-37 weeks

what is the prognosis and treatment for placental previa

planned elective c/s at 38-39 weeks

what percent of women with placental accreta, increta, percreta and previa will have an emergency c/s before 38 weeks due to increased bleeding before birth

40%

what is involved in preoperative planning of placental accreta, increta, percreta and previa

multidisciplinary involvement, should be directly supervised by obstetrician, blood and blood product must be available, cell salvage should be considered, level 2-critical care bed available on site

what does level 2 critical care involve

central venous line, arterial line for constant measuring of arterial pressure, sampling of arterial blood, intravenous rhythm controlling drugs to support or control cardiac arrhythmias

what is placental abruption

complete or partial separation of the placenta before delivery

what are the clinical findings for placental abruption

vaginal bleeding, abdominal pain, contractions, fetal distress

can placental abruption cause maternal morbidity and mortality

yes

what is the management for placental abruption

maternal and fetal monitoring, emergency c/s, fluid management - blood transfusion and plasma transfusion

although c/s may seem most appropriate for placental abruption - what are the risks of c/s

increased blood loss, escalation of consumptive/generalised coagulation, possible emergency hysterectomy THEREFORE VAGINAL BIRTH IS STILL PREFERRED IF POSSIBLE

what is a major contraindication for vaginal birth with placental abruption - even though placental abruption is preferred to c/s if possible

maternal or fetal hemodynamic status