The term morbidly adherent placenta implies an abnormal implantation of the placenta into the uterine wall and has been used to describe placenta accreta, increta, and percreta. Placenta accreta is a placenta where the placental villi adhere directly to the myometrium. Placenta increta is a placenta where the placental villi invade into the myometrium; and placenta percreta is a placenta where the villi invade through the myometrium and into serosa (1).
Placenta accreta is a significant cause of maternal morbidity and mortality and is presently the most cause of peripartum hysterectomy (2)
The exact etiology is unknown, but it has been postulated to be related to damage of the decidua basalis, which allows for placental invasion…show more content… no antenatal diagnostic technique aﬀords the clinician 100% assurance of either ruling in or ruling out the presence of placenta accreta. The deﬁnitive diagnosis of placenta accreta is usually made postpartum on hysterectomy specimens when an area of accretion shows chorionic villi in direct contact with the myometrium and absence of deciduas.(11)
-Placenta accreta should be suspected in women who have both a placenta praevia, particularly anterior, and a history of cesarean or other uterine surgery. The most important factor aﬀecting outcome is prenatal diagnosis of this condition It gives the opportunity to make a delivery plan that properly anticipates the expected blood loss and other potential complications of delivery. In addition, it gives the opportunity for electively timing the procedure since prevention of complications ideally requires the presence of a multidisciplinary surgical team.(12)
-Antenatal ultrasound is the technique of choice used to establish the diagnosis and guide clinical…show more content… (12) Magnetic resonance imaging (MRI)
Ultrasonography and MRI are comparable in diagnosing placenta accreta. The latter has additional value in detecting depth of placental invasion and depicting posterior placenta accrete However, there is insufficient evidence to support routine MRI scanning of patients with sonographically suspected placenta accreta to improve management and outcome . MRI is often recommended when ultrasound findings are inconclusive (18) If the ultrasound ﬁndings are not considered deﬁnitive or the placenta is located on the posterior wall, magnetic resonance imaging MRI can be performed. Magnetic resonance imaging ﬁndings considered suspicious for the presence of placenta accrete include placental heterogeneity, uterine bulging ,tenting of the bladder , heterogeneous signal intensity within the placenta , mass eﬀect of the placenta into the underlying bladder or extending beyond the normal uterine contour, obliteration of the myometrial zone, and a beading nodularity within the placenta.(29)
Dark intraplacental bands can also be seen, appearing as nodular or linear areas of low signal intensity on T2-weighted