30 Apr 2019
Pregnancy is a delicate period during which a rigorous gynecological follow-up is essential. Although most of the time it goes well, complications can occur during this gestational period, endangering the baby and mother.
One of these complications, rare but frequent in recent years, is placenta accreta.
What is a placenta accreta?
The placenta is an organ that forms during pregnancy. Its role is to ensure the proper development of the fetus through vital exchanges with the mother.
A placenta is accreta when this organ is inserted into the myometrium (muscle of the lining of the uterus) instead of attaching itself to the uterine lining. The placenta is expelled about 30 minutes after delivery but in the case of placenta accreta, the placenta remains attached to the uterine wall and causes severe postpartum hemorrhage.
There are cases of bleeding from the placenta or rupture of the pockets of water, and to save the baby and his mother, the gynecologist makes use of a premature delivery by caesarean section.
Diagnosis
Often without symptoms, placenta accreta can be diagnosed after bleeding during or at the end of pregnancy. It is detectable by obstetrical ultrasound and can only be confirmed by magnetic resonance imaging (MRI).
Often a silent pathology, the obstetrician can diagnose it during a vaginal birth or caesarean section.
Risk factors
This rare pathology has become common in recent years. From unknown causes, this anomaly is formed on the uteri scarred following an anterior caesarean section, an obstetric surgery (uterine myoma) or in patients who have undergone several IVG curettage.
Its management
Given the increase in cases of placenta accreta and the serious dangers incurred by the mother and her baby, care must be early and rigorous.
The patient must be informed to plan the delivery in special therapeutic conditions and to make the right decisions with her obstetrician.
Two alternative care options are possible, premature delivery by caesarean section to stop bleeding and reduce the risk of bleeding by complete extraction of the placenta from the myometrium with adequate medical management during and after delivery (hemostatic treatment, blood transfusion ...) if the patient is desirous of another pregnancy and wants to preserve the uterus.
The second alternative for the obstetrician, which depends on the intensity of the bleeding and the condition of the uterus (risk of tearing the uterine muscle) is hysterectomy, a radical solution that is mandatory in view of the severity of the case.
Hysterectomy is the removal of the uterus after cesarean section to avoid the risk of hemorrhage, it leads to permanent sterility.
In cases of placenta perforera where the placenta pierces the uterine wall to extend to the neighboring organs and placenta increta where the placenta invades the entire uterine walls, hysterectomy remains the only solution for the obstetrician.
