The placenta is normally slightly attached to the lining of
the uterus and can be easily removed after childbirth or during cesarean
section. If the placenta adheres to the uterine wall deeply and tightly, it is
called placenta accreta. If this adhesion is deep enough to reach the muscle
layer in the uterine wall, it is called placenta increata. The state of
adhesion deep enough to go beyond the wall of the uterus or even to the organs
such as the bladder in the environment is called placenta percreata. 75% of the
cases are acreata, 15% increata, 10% percreata. These placental adhesion
abnormalities are commonly referred to as "placental invasion anomalies
(plancenta adhesion disorders)".
It is more common in those who had previous cesarean or
uterine surgery (such as uterine surgery). Especially with the increase of
cesarean rates in recent years, the frequency of placenta accreta increased to
1 in 1000 births. The risk of placenta accreditation increases as the number of
cesarean sections increases, the risk reaches 70% in those who have had 3-4
cesarean sections.
Those who are diagnosed with ultrasound placenta previa
during pregnancy have a risk of accompanying placenta accreta.
Risk
factors:
- Placenta previa
- Cigaret
- Multiparite
- Having undergone uterine surgeries such as cesarean
section, metroplasty
Diagnosis:
It is not possible to diagnose placenta acreata (and increta,
percreata) before birth. Diagnosis cannot be made by examination or
ultrasonography. The diagnosis is made by not leaving the placenta from the
mother's womb during normal delivery or cesarean. Sometimes the placenta is
detached, but some of its parts are adhered to the uterus, meaning that the
separation is not complete, which causes bleeding. Diagnosis before birth may
rarely be possible in some pregnant women suspected of history, evaluated by
ultrasonography or MR.
Treatment:
It is not possible to prevent placenta accretion. At the time
of diagnosis, if the mother has given birth normally, the abdominal parts can
be cleaned with an abortion. Sometimes this is not possible and it may be
necessary to remove the entire uterus by surgery to stop excessive bleeding.
Similarly, during caesarean section, it may cause enough bleeding to require
removal of a ramin (hysterectomy). Bleeding can occur seriously enough to
endanger maternal life. However, it is not always necessary to take the uterus.
Often the placenta is removed from the uterine wall by force, and bleeding
stops when the remaining parts are cleaned.
Conservative treatment: In some studies, it was attempted to
terminate the operation and to follow up the patient by leaving the placenta in
place, without forcing the separation of the placenta and removing the uterus
by surgery, in deliveries diagnosed with placenta accreta. During the
follow-up, there were patients who were given methotecate or underwent uterine
artery embolization. In some of these patients, it was observed that the
placenta was separated and disappeared by itself. However, conservative treatment
is not yet routinely applied in practice.
-UMBILICAL CORD AROUND BABY’S NECK
-LOW AMNIOTIC FLUID IN PREGNANCY
-HIGH AMNIOTIC FLUID IN PREGNANCY
-PREMATURE MEMBRANE RUPTURE
-FETAL DISTRESS
