Placenta accreta: the silent invader

Seema Dwivedi, Gopaal Narayan Dwivedi, Archana Kumar, Neena Gupta, Vinita Malhotra, Neha Singh


Background: To review incidence causes, clinical presentations, management, maternal mortality and morbidity associated with placenta accreta.

Methods: A prospective study was carried out at the Department of Obstetrics and Gynaecology, GSVM Medical College, Kanpur during the period of January 2010 to December 2014. During this period all the patients who were diagnosed with placenta accreta were included in the study.

Results: Majority of patients presenting with placenta accreta belonged to age group 30-35 years (46%) were multigravida (95%) came from both rural and urban background. Majority of deliveries complicated by placenta accrete were booked cases (78%). Previous LSCS with placenta previa proved to be the major cause (86%). Out of whole spectrum including placenta accreta, increta, percreta, placenta accreta was the commonest of all and placenta percreta required maximum number of blood transfusions (5-6 units of blood on an average). Hysterectomy was required in 29 cases out of 37 (78%), 6 women suffered from bladder injury which were repaired. Among total of 37 women 7women couldn't be saved even after our best of efforts.

Conclusions: Incidence of placenta accrete has increased now a days because of increased incidence of cesarian sections, placenta accreta was seen in primi due to uterine procedures  done deliberately  in both diagnostic and therapeutic indications. Morbidly adherent placenta is always a nightmare for the obstetrician. Suspicion of a case on history, preoperative confirmation of diagnosis, planned management with bundle of care, with multi-disciplinary approach can save many patients from the clutches of inevitable death.


Placenta accreta, Cesarian

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Upson K, Silver RM, Greene R. Placenta accreta and maternal morbidity in the Republic of ireland, 2005-2010. J Matern Fetal Neonatal Med. 2014:27(1):24-9.

Inograd A, Waistock T, Mazor M. Placenta accereta is an independent risk factor for late pre-term birth and perinatal mortality. J Matern Fatel Neonatal Med. 2014;1-7.

Palacious Jaraquemada JM. Diagnosis and management of placenta accreta Best Pract Res Clin Obstet Gynaeol. 2008;22(6):1133-48.

Garmi G, Salim R. Epidemiology, etiolopgy, diagnosis, and management of placenta accreta. Obstet Gyneol Int. 2012;2012(8):873929.

MacDorman MF Manacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. 2008:35(2):293-307.

Khong TY. The Pathology of placenta accreta, a worldwide epidemic. J Clin Pathology. 2008;61(12):1243-6.

Silver RM, London MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-32.

Silver RM. Implication of the first cesarean: Perinatal and future reproductive health and subsequent cesareans. placentation issues, uterine rupture risk, morbidity and mortality. cesareans, placentation issue, uterine rupture risk morbidity,and mortality. Semin Perinatol. 2012;36(5);315-23.

Gyamfi-Bannerman C, Gilbert S, LOndon MB. Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. Obutet Gyecol. 2012;120(6):1332-7.

Belfort MA. Placenta accreta. A J Gynecol. 2010:203(5):430-9.

Comstock CH, Bronsteen RA. The antenatal diagnosis of placenta accreta. BJOG. 2014:121(2):171-81.

Chen YJ, Wang PH, LIu WM. Placeta accreta diagnosed at 9 weeks’ gestation. Ultrasound Obstet Gynol. 2002;19(6):620-2.

Morettin F, Merziotis M, Ferraro ZM. The importance of a last first trimester placental sonogram in patients at risk of abnormal placentation.Case ep Obstet Gynecol. 2014;2014(9):345348.

Chou MM, Ho ES, Lee YH. Prenatal diagnosis of placenta previa accreta by transabdominal colour Doppler ultrasound. Ultrasoud Obstet Gynol. 2001;17(1):28-35.

Chou MM, Tseng JJ, Hwang Jl. Sonographic appearance of tornado blood flow in placenta previa accreta/increta. Ultrasound Obstet Gynol. 2001;17(4):362-3.

Eller AG, Porter TF, Soisson P. Optimal management strategies for placenta accreta. BJOG. 2009;116(5):648-54.

Warshak CR, Ramos GA, Eskandar R. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta Obstet Gynol. 2010;115(1):65-9.

Fizpatrick Ke, Seller S, Spark P. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG. 2014;121(1):62-70.

Bretalle F, Courbiere B, Mazouni C. Management of placenta accreta. morbidity and outcomes.Eur J Obstet Gynol Reprod Biol. 2007;133(1):34-9.