User:Mr. Ibrahem/Placenta accreta spectrum

Placenta accreta spectrum
Other names	Placenta accreta, morbidly adherent placenta
Types of placenta accreta
Specialty	Obstetrics
Complications	Postpartum bleeding, disseminated intravascular coagulopathy, bladder injury
Types	Accreta, increta, percreta
Risk factors	Prior C-sections, high number of pregnancies, older age, uterine surgery, pelvic irradiation
Diagnostic method	Based on ultrasound
Treatment	C-section at 34 to 36 weeks, blood transfusion, hysterectomy
Frequency	1 in 272 pregnancies

Placenta accreta is when the placenta attaches abnormally into the muscular layer of the uterine wall rather than just to the endometrium. The most common complication is postpartum bleeding, with other potential complications including disseminated intravascular coagulopathy (DIC) and bladder injury. The baby is also at higher risk of a poor outcome.

Risk factors include prior C-sections, a high number of prior pregnancies, older age, uterine surgery, and pelvic irradiation. Three grades of disease are defined by the depth of attachment into the muscular layers: accreta, increta, and percreta. In accreta chorionic villi attach to the myometrium, in increta they invade into the myometrium, while in percreta they invade to the outside of the uterus. Diagnosis is generally by ultrasound, though magnetic resonance imaging may occasionally be used.

Treatment often involve early delivery at 34 to 36 weeks via a C-section. Sufficient blood should be avaliable incase transfusion is required. If the placenta does not deliver, a hysterectomy is recommended though some techniques may be able to preserve fertility. Tranexamic acid may be used to try to decrease blood loss. Rates of placenta accreta have increased from the 1960s to the 2010s. As of 2016, they affect an estimated 1 in 272 pregnancies.