As placenta accreta is called an unusually tightly adherent placenta, leading to a delayed delivery of the placenta. Placental function is normal, but the trophoblast invasion extending beyond the normal limit (so called Nitabuch layer). In such cases, the manual removal of the placenta leads, except for conscientious approach to massive postpartum hemorrhage. Prenatal diagnosis is carried out using ultrasound. The treatment is usually from a planned caesarean section with hysterectomy.
ei placenta accreta the placental not contain uterine decidual cells, as is normal, but penetrate into the myometrium.
As placenta accreta is called an unusually tightly adherent placenta, leading to a delayed delivery of the placenta. Placental function is normal, but the trophoblast invasion extending beyond the normal limit (so called Nitabuch layer). In such cases, the manual removal of the placenta leads, except for conscientious approach to massive postpartum hemorrhage. Prenatal diagnosis is carried out using ultrasound. The treatment is usually from a planned caesarean section with hysterectomy. ei placenta accreta the placental not contain uterine decidual cells, as is normal, but penetrate into the myometrium. To related anomalies include placenta increta (invasion of chorionic villi in the myometrium) placenta increta (penetration of the chorionic villi into or through the Uterusserosa). All three anomalies cause similar problems. Etiology The most important risk factor for placenta accreta is Prior uterine surgery in the United States enters a placenta accreta most frequently in women who have placenta previa and had a cesarean section in a previous pregnancy. The incidence of placenta accreta has about 1 / 30,000 in the 1950s, increased about 1/500 to 2,000 in the 1980s and 1990s and to 3/1000 in the 2000s; it remains in the range of about 2/1000. The risk in women with placenta previa increases of about 10% when they had a Caesarean section, to> 60% if they had> 4 cesarean deliveries. For women without placenta previa after earlier caesarean section increases the risk of very low (<1% for up to four Caesarean sections). Other risk factors include the following: Maternal age> 35 years multiparity (risk increases as with increasing parity) submucosal fibroids Previous uterine surgery, including Myektomi endometrial lesions such as Asherman’s Syndrome symptoms and complaints Normally there is a heavy vaginal bleeding during the manual separation of the placenta after the birth of the fetus. However, the bleeding may be minimal or absent, but the placenta does not develop within 30 minutes after delivery of the child. Diagnostic ultrasound in women at increased risk of a thorough investigation of the uteroplacental connection using ultrasound (transvaginal or transabdominal) is indicated for women at risk; it can be carried out at regular intervals, starting with the 20th-24th SSW. Provides the ultrasound B-mode (gray scale) no clear finding an MRI or Doppler studies may be helpful. In the course of birth placenta accreta is suspected if the placenta is not developed within 30 minutes after the birth of the child. Attempts to manual removal can be brought about no separation. Train causes massive bleeding in the placenta. When a placenta accreta is suspected, it is necessary to prepare for a laparotomy with high blood loss. Treatment Planned caesarean hysterectomy with preparation for birth is best. Normally, unless the woman has objections, a caesarean section with hysterectomy after 34 weeks is carried out, this approach seems best for both the mother and the fetus to be. If a caesarean section with hysterectomy is performed (preferably by an experienced surgeon Beck), a Fundusinzision followed by immediate-clamping the umbilical cord after delivery in minimizing blood loss may be helpful. The placenta is maintained during hysterectomy in situ. A balloon occlusion of the aorta or internal iliac vessels can be performed preoperatively, but requires an experienced in angiography experts and can have serious thromboembolic complications. In rare cases (. For example, when a placenta accreta locally, posterior or is present in the fundus) is trying to save the uterus, but only if no acute hemorrhage is present; for example, the uterus may be left and a high methotrexate dose will be given to solve the placenta. Occasionally, embolization of the uterine arteries, arterial ligation and balloon tamponade be applied. Summary In the United States takes the placenta accreta to become increasingly frequent, most common in women, the placenta previa and have had a Caesarean section in a previous pregnancy. To investigate a regular ultrasound in women aged> 35 years or multiparas should (especially when a placenta has developed previa before or a previous caesarean section is present) be considered who submucosal fibroids or endometrial lesions or surgical intervention on had had the uterus. A placenta accreta is assumed when the placenta does not develop within 30 minutes after the birth of the child if induce attempts at manual removal is no separation or if train leads to the placenta to a massive hemorrhage. If a placenta accreta diagnosed, a caesarean section is performed with hysterectomy in 34 weeks.