Published: 2017-10-28

Abnormally invasive placenta: an overview of diagnosis and management options

Parveen Rajora, Amanjot Singh


Background: Abnormally invasive placenta, also known as morbidly adherent placenta, is a broad term that describes abnormal adherence of placenta to the underlying myometrium. Clinical risk factors include placenta previa and prior uterine surgery, including caesarean delivery. The diagnosis and management of women at risk is not only based on clinical parameters, but also driven by imaging, namely ultrasound and more recently magnetic resonance (MRI) imaging.

Methods: This is a retrospective analysis of 10 cases of abnormally invasive placenta undertaken at Guru Gobind Singh Medical College and Hospital, Faridkot.

Results: Hysterectomy done in six cases and uterus was preserved in four cases. Foetal outcome was on average side. Four foetal losses noted two because of prematurity and two due to excessive blood loss admitted with intra uterine foetal death. Two babies needed NICU care but successfully discharged.

Conclusions: Newer approaches should be considered investigational until larger prospective series to become available, until then hysterectomy should remain the stay of treatment specially when the family is complete and there is life threatening Haemorrhage.


Abnormally invasive placenta, Hysterectomy, MRI, Ultrasonography

Full Text:



Chantraine F, Langhoff-Roos J. Abnormally Invasive placenta-AIP. Awareness and pro-active management is necessary. Acta Obstet Gynecol Scand. 2013;92:369-71.

Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLOS ONE. 2012;7(12).

Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y. Placenta accrete-summary of 10 years: a survey of 310 cases. Placenta. 2002;23:210-4.

Dwyer BK, Belogolovkin V, Tran L, Rao A, Carroll I, Barth R, et al. Prenatal diagnosis of placenta accreta. J Ultrasound Med. 2008;27:1275-81.

Royal College of Obstetricians and Gynaecologists. Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management. Green top Guideline no 27 London UK 10. 2011;3:1-26.

Kayem G, Davy C, Goffinet F, Thomas C, Clement D, Cabrol D. Conservative versus extirpative management in cases of placenta accreta. Obstet Gynecol. 2004;104:531-6.

Grace Tan SE, Jobling TW, Wallace EM. Surgical Management of placenta accreta: a 10-year experience. Acta Obstet Gynecol Scand. 2013;92:445-50.

Nishida R, Yamada T, Akaishi R, Kojima T. Usefulness of transverse fundal incision method of cesarean section for women with placentas widely covering the entire anterior uterine wall. J Obstet Gynaecol Res. 2013;39:91-5.

Dubois J, Garel L, Grignon A, Lemay M, Leduc L. Placenta percreta: balloon occlusion and embolization of the internal iliac arteries to reduce intraoperative blood losses. Am J Obstet Gynecol 1997;176(3):723-6.

Wu Q, Liu Z, Zhao X, Liu C, Wang Y, Chu Q, et al. Outcome of pregnancies after balloon occlusion of the infrarenal abdominal aorta during caesarean in 230 patients with placenta praevia accreta. Cardiovascular Interventional Radiol. 2016;39(11):1573-9.

Reyes RM, de Ávila RC, Vázquez MD, Monteagudo CA, Zerón HM. Sclerotherapy with 6% polidocanol solution in patients with placenta accreta. Taiwanese J Obstet Gynecol. 2016;55(5):654-8.

Guex, JJ. Complications and side-effects of foam sclerotherapy. Phlebol. 2009;24(6): 270-4.

Fox H. Placenta accreta 1945-1969. Obstetrical Gynecological Survey. 1972;27(7):475-90.

Dasari P, Venkatesan B, Thyagarajan C, Balan S. Expectant and medical management of placenta increta in a primiparous woman presenting with postpartum haemorrhage: The role of imaging. J Radiol Case Reports. 2010;4(5):32.

Palacios Jaraquemada JM, Pesaresi M, Nassif JC, Hermosid S. Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand. 2004;83:738-44.

Welsh AW, Ellwood D, Carter J, Peduto AJ, Veelago J, Bennett M. Opinion: integration of diagnostic and management perspectives for placenta accrete. Aust N Z J of Obstet Gynecol. 2009;49:578-87 .

Matsubara S, Kuwata T, Usui R, Watanabe, Izumi A, Ohkuchi A, et al. Important surgical measures and techniques at cesarean hysterectomy for placenta previa accreta. Acta Obstet Gynecol Scand. 2013;92:372-7.

Tam Tam KB, Dozier J, Martin JN Jr. Approaches to reduce urinary tract injury during management of placenta accreta, increta, and percreta: a systematic review. J Matern Fetal Neonatal Med. 2012;25(4):329-34.