Placenta accreta is a severe obstetric complication involving an abnormally deep attachment of the placenta, through the endometrium and into themyometrium (the middle layer of the uterine wall). There are three forms of placenta accreta, distinguishable by the depth of penetration.
The placenta usually detaches from the uterine wall relatively easily, but women who encounter placenta accreta during childbirth are at great risk ofhaemorrhage during its removal.
diagnosis
Placenta accreta is very rarely recognised before birth, and is very difficult to diagnose.
A Doppler ultrasound can lead to the diagnosis of a suspected accreta and an MRI will give more detail leading to further suspicion of such an abnormal placenta.
However, both the ultrasound and the MRI rarely confirm an accreta with certainty.
While it can lead to some vaginal bleeding during the third trimester, this is more commonly associated with the factors leading to the condition.
In some cases the second trimester can see elevated maternal serum alpha-fetoprotein levels, though this is also an indicator of many other conditions[3].
During birth, placenta accreta is suspected if the placenta has not been delivered within 30 minutes of the birth. Usually in this case, manual blunt dissection or placenta traction is attempted but can cause haemorrhage in accreta.
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