Placenta creta

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Placenta creta is an uncommon pathology of placental attachment.

General

  • What?
    • Trophoblastic tissue deeper than it should be, so the placenta fails to separate at time of delivery
  • Clinical?
    • Failure of placenta to deliver spontaneously.
    • Postpartum hemorrhage leading to a hysterectomy.[1]
    • May be associated with antepartum hemorrhage.
    • Discovered on ultrasound during pregnancy, especially when associated with placenta previa
  • Pathogenesis?
    • It is suspected that it arises as there is defect in the endometrium/myometrium -- not deep trophoblastic invasion.[1]
    • Risk factors:[2]
      • Placenta previa.
      • Previous caesarian section.

Note:

  • Normal: trophoblastic tissue attaches to the decidua.[3]
  • Retained placentas have less multinucleated trophoblastic giant cells.[4]

Placenta accreta

  • Trophoblastic tissue (directly) adherent to the myometrium.[3]

Image:

Placenta increta

  • Placenta (i.e. trophoblastic tissue) extends into the myometrium but not through.[6]

Placenta percreta

  • Trophoblastic tissue penetrates through the myometrium.

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PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITHIN NORMAL LIMITS, AND A 
  DISRUPTED MATERNAL SURFACE COMPATIBLE WITH A HISTORY OF PLACENTA ACCRETA.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- FETAL MEMBRANES WITHIN NORMAL LIMITS.

See also

References

  1. 1.0 1.1 Tantbirojn, P.; Crum, CP.; Parast, MM. (Jul 2008). "Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast.". Placenta 29 (7): 639-45. doi:10.1016/j.placenta.2008.04.008. PMID 18514815.
  2. Wortman, AC.; Alexander, JM. (Mar 2013). "Placenta accreta, increta, and percreta.". Obstet Gynecol Clin North Am 40 (1): 137-54. doi:10.1016/j.ogc.2012.12.002. PMID 23466142.
  3. 3.0 3.1 Böcker, Werner; Denk, Helmut; Heitz, Philipp U.; Moch, Holger (2008). [Pathologie] (4th ed.). Urban & Fischer Verlag/Elsevier GmbH. pp. 974. ISBN 978-3437423826.
  4. van Beekhuizen, HJ.; Joosten, I.; de Groot, AN.; Lotgering, FK.; van der Laak, J.; Bulten, J. (Sep 2009). "The number of multinucleated trophoblastic giant cells in the basal decidua is decreased in retained placenta.". J Clin Pathol 62 (9): 794-7. doi:10.1136/jcp.2009.065953. PMID 19734475.
  5. URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/plfrm.html. Accessed on: 3 December 2011.
  6. Silver, RM.; Barbour, KD. (Jun 2015). "Placenta Accreta Spectrum: Accreta, Increta, and Percreta.". Obstet Gynecol Clin North Am 42 (2): 381-402. doi:10.1016/j.ogc.2015.01.014. PMID 26002174.