What is morbidly adherent placenta?
Morbidly adherent placenta (MAP) occurs when the placenta fails to detach from the uterine wall due to abnormal implantation at the basal plate. This often leads to massive obstetric hemorrhage and sequelae such as need for blood transfusion, multiorgan failure, need for morbid hysterectomy and even death1.
How common is placenta accreta UK?
Placenta accreta is a rare (between 1 in 300 and 1 in 2000) complication of pregnancy. This is when the placenta grows into the muscle of the uterus, making delivery of the placenta at the time of birth very difficult.
What are the grades of placenta previa?
Placenta praevia is graded into 4 categories from minor to major. If you have grade 1 or 2 it may still be possible to have a vaginal birth, but grade 3 or 4 will require a caesarean section. Any grade of placenta praevia will require you to live near or have easy access to the hospital in case you start bleeding.
How is morbidly adherent placenta diagnosed?
Ultrasound is recommended as the first-line imaging modality for diagnosis of invasive placenta. In some cases, diagnosis is possible in the first trimester. Abnormalities include a cesarean scar ectopic pregnancy or implantation of the gestational sac in the lower third of the uterus, defined as a “low implantation”.
Is placenta accreta life threatening?
In placenta accreta, the placenta has grown into the uterine wall and does not separate easily following delivery. In severe cases, this condition can lead to excessive bleeding, which can be life-threatening. It can require a blood transfusion and even hysterectomy (removal of the uterus).
Is placenta accreta serious?
Placenta accreta is a serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall. Typically, the placenta detaches from the uterine wall after childbirth. With placenta accreta, part or all of the placenta remains attached. This can cause severe blood loss after delivery.
Is placenta previa life-threatening?
The doctor may do a speculum vaginal examination very gently to make sure the bleeding is not coming from the cervix or vagina. Once the diagnosis is made, the pregnancy needs to be very carefully monitored. Placenta previa is a potentially life-threatening condition for the both the mother and her baby.
Morbidly adherent placenta refers to an abnormal invasion of the placental tissue (trophoblasts) into inner or outer myometrium or through the serosa of the uterus (termed accreta, increta or percreta, respectively.)
What are conservative and radical management of the placenta associated with?
Conservative management (intentional retention of the placenta or IRP) and radical management (peripartum hysterectomy) are associated with increased maternal morbidity
What causes morbidly adherent placenta after caesarean section?
In addition to the disruption of the decidua basalis caused by caesarean section or uterine surgery, previous intra-uterine infection (endometritis) and vigorous uterine curettage can also result in morbidly adherent placenta.
What is the prevalence of placenta previa after cesarean section?
1 in 400 pregnancies. Placenta previa with history of previous cesarean section (CS): 3% for 1 CS, 10% for 2 CS, >50% for ≥3 CS. A morbidly adherent placenta includes placenta accreta (chorionic villi attach to myometrium), increta (chorionic villi invade into the myometrium) and percreta (chorionic villi invade through the myometrium).