Placenta Acrreta

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  • Topic: Vagina, Vulva, Uterus
  • Pages : 22 (6426 words )
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  • Published : September 16, 2011
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I. INTRODUCTION
PLACENTA ACCRETA
The abnormal adherence of the chorionic villi (vascular fingers of the chorion, a part of the placenta) to the myometrium (the muscle of the uterus). Normally, there is tissue intervening between the chorionic villi and the myometrium but in placenta accreta, these vascular processes of the chorion grow directly in the myometrium.

Placenta accreta occurs when your placenta attaches too firmly to the inside wall of your uterus. This is a rare disorder, occurring in only 1 in 5000 pregnancies, and is associated with serious complications. There are three variants of placenta accreta:  Placenta Accreta: occurs when the placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle. This is the most common accounting for approximately 75% of all cases. Placenta Increta: occurs when the placenta attaches even deeper into the uterine wall and does penetrate into the uterine muscle. This accounts for approximately 15% of all cases.  Placenta Percreta: occurs when the placenta penetrates through the entire uterine wall and attaches to another organ such as the bladder. This is the least common of the three conditions accounting for approximately 5% of all cases.

Risk Factors for Placenta Accreta
You are at increased risk for placenta accreta if:
* you have placenta previa (the placenta covers the cervix); * you have a history of cesarean section or other operations on the uterus; * your placenta is implanted over a scar in the uterus

* you are over age 35;
* you have been pregnant before; or
* you have had your uterine lining scraped during dilation and curettage procedure. * Ruptured uterus that cause scar

Complications of Placenta Accreta

Placenta accreta is connected with severe complications. Because the placenta is so firmly attached to the uterus, it can make it difficult for you to deliver the placenta after you have given birth. It is possible that the uterus will become damaged or torn as you try to pass the placenta afterbirth. Placenta accreta also causes those contractions that occur after labor to stop. These contractions play a role in minimizing blood loss. As a result, placenta accrete can cause serious hemorrhaging.

MEDICAL MANAGEMENT

Conservative treatment is done if the woman wants to maintain her fertility under the condition that no active bleeding is present. This treatment saves the uterus but poses higher risk of complications and low successful rate. Techniques for this treatment are as follows:

* The placenta is left in the uterus and the cord is ligated. * Closure of the uterus is performed.
* Methotrexate (an antineoplastic agent) is usually given to the woman to destroy the still attached placenta. Women taking Methotrexate should be monitored for:
* WBC and platelet count (thrombocytopenia and leucopenia may occur 7-14 days after the initiation of treatment) * Blood Urea Nitrogen (BUN), Creatinine, and urine pH (should be above 7.0) * Presence of dry and nonproductive cough may be an early sign of pulmonary toxicity * Symptoms of gout must be assessed frequently (increased uric acid, joint pain, edema). Methotrexate causes increase serum uric acid. Allopurinol may be given to decrease uric acid levels.

After the techniques are implemented, prophylactic antibiotic is started to prevent infection.  Follow-up includes frequent or daily ultrasound sessions to monitor uterine involution and placental condition.

Surgical Management
Early detection of placenta accreta will prevent serious complication. The safest modality is aplanned cesarean section and hysterectomy (surgical removal of the uterus).

Nursing Management
1. Obtain a detailed obstetric history.
2. Assist with modalities implemented.
3. For clients taking Methotrexate, instruct the woman to increase fluid intake to at least 2 L each day as uric acid formation is increased with the drug...
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