Placenta Acreata and Percreata

The placenta is a lining that forms on the inner wall of the uterus during pregnancy, popularly known as the baby’s partner.
is an organ. It is connected to the baby by the umbilical cord and is a substance between the mother’s blood and the baby’s blood.
exchange of nutrients. Through the placenta, nutrients and oxygen pass from the mother’s blood to the baby, while waste
substances pass from the baby’s blood into the mother’s blood and are excreted from the body. In this way, the nutrients
Another function of the placenta is to secrete certain hormones important for pregnancy.
The placenta is a very important organ during pregnancy, but after birth it
The placenta is completed and is separated from the uterine wall by uterine contractions and excreted from the body.

What are placenta adhesion anomalies?
However, sometimes all or part of the placenta adheres deeply to the uterine wall, this is called
placenta adhesion, which we call placenta acreata, increata and percreata.
anomalies occur. Adhesion of the placenta to the uterus is called placenta accreta, placenta
placenta increata, when it adheres to the serosa layer outside the uterus.
If it progresses as far as the placenta, it is defined as placenta percreata. The most severe placenta
In perforation, the placenta can progress like a tumor to the bladder and extrauterine organs.

Why are placenta acreata, increata and percreata risky?
In these anomalies, in which the placenta adheres to the uterine wall, the placenta can be detached from the uterus after birth.
cannot be separated. Forced separation is because the placenta is a very bloody organ.
because it can cause severe bleeding. Therefore, placenta acreata, increata and
Patients with percreata should be followed more closely than other pregnant women and their treatment should be planned specially.

How common are placenta acreata, increata and percreata?
Placental adhesion anomalies occur approximately once in 600 women. 63 percent of these
placenta acreata is the mildest. This is followed by placenta increata with 15 percent and placenta acreata with 10 percent.
followed by placenta perforata.

Why do placenta acreata, increata and percreata occur?
Although the cause of placental adhesion anomalies is not known for certain, some possible theories are
is present. In a normal pregnancy, the endometrium tissue in the uterus
In preparation, it thickens, forming a tissue called a decidua for the placenta to attach to. The uterus
damage to the tissue due to previous surgery, etc., resulting in a decrease in the decidua during pregnancy.
underdevelopment can cause the placenta to attach incorrectly to the uterus
is being considered. One of the new theories is the scarring that occurs after damage to the uterine tissue.
fibrin deposition in the uterine tissue, which causes the placenta to invade and adhere to the uterus.
is one of the factors. 80 percent of patients with placenta accreta have had a previous cesarean section
a history of childbirth, curettage or myomectomy (surgery to remove fibroids) supports these two theories.
support.

The rare occurrence of placenta accreta in the first pregnancy is due to the uterine bicornus (uterus at birth).
heart-shaped), adenomyosis, uterine fibroids such as fibroids in the inner wall of the uterus
pathologies, endometrial damage at the microscopic level, endometrial
function, affecting the adhesion of the placenta.
Who is at risk for placenta acreata, increata and percreata?
History of cesarean section: The most important risk factor for placenta acreata is a history of cesarean section.
is to have a cesarean section. As the number of caesarean sections increases, the risk of placental adhesion anomalies also increases. First time
the risk of placenta acreata after cesarean section was 3 percent, 11 percent after the second, and 11 percent after the third
The risk of placenta accreta after cesarean section increases to 40 percent!

Placenta Previa : A condition in which the placenta is close to the cervix or closes the cervix
is called placenta previa. The decidua to which the placenta attaches in the area near the cervix
The placenta cannot attach to the uterus in a healthy way due to insufficient tissue. This can lead to
Therefore, placenta accreta is usually associated with placenta previa.
Abortion History : Abortion damages the endometrium tissue in the uterus, which can lead to
increases the chance of the placenta sticking.
Uterine surgeries : uterine surgery such as myomectomy (fibroid removal surgery)
may increase the risk of placenta accreta as it may damage the tissue.
Fibroids in the inner wall of the uterus (submucosal fibroids): Due to endometrial damage
placental adhesion may be impaired.
Intrauterine adhesions (e.g. Asherman syndrome): Placenta due to endometrial damage
adhesion may be impaired.
Multiparity (having had many births)
Advanced maternal age: Pregnancies over 35 years of age have a higher risk of placenta acreata.

What are the symptoms of placenta acreata, increata and percreata?
Placenta acreata is usually asymptomatic throughout pregnancy.
Rarely, it may cause vaginal bleeding towards the last weeks of pregnancy. But mostly
placenta acreata and other placental adhesion anomalies during routine pregnancy examinations
detected by ultrasound.
How are placenta acreata, increata and percreata diagnosed?
Placenta acreata can be detected by ultrasound in routine pregnant examinations.
In patients with suspicion, imaging methods such as MRI and maternal blood alpha-
fetoprotein test can also be used. AFP levels are elevated in placenta acreata, increata and percreata
monitored.

How are patients with placenta acreata, increata and percreata followed?
Placenta acreata usually does not cause any problem during pregnancy. The most important problem is birth
after the placenta does not detach spontaneously and attempts to detach the placenta
is that it causes serious threatening bleeding. In patients diagnosed with placenta acreata
prenatal planning is done.

The only delivery option in patients with placenta acreata, increata and percreata is cesarean delivery.
Generally, delivery is planned at 34.-36 weeks.
Due to the risk of bleeding, blood bank blood transfusion is performed in the blood bank before delivery.
is prepared. Because it is a risky delivery, patients with placenta accreta
cannot be operated, delivery is planned in a center with appropriate intensive care conditions.
Treatment of patients with placenta acreata, increata and percreata
In most of these patients, the removal of the baby is followed by a hysterectomy (surgical removal of the uterus
removal) is necessary. Placenta accreta is a complication of postpartum hysterectomies (removal of the
removal) is the cause of about half of them. Because it is a risky operation, placenta
cesarean sections for patients with acreata, increata and percreata must be performed by an experienced surgeon.
must be done by

In patients with placenta accreta, if the patient wants to have a baby again, uterine protection
(conservative) surgery may be tried. In this surgery, the placenta is removed after the baby and the adhering
The parts are scraped with a curette and bleeding is tried to be stopped with additional sutures or tamponade. However.
there is a high risk of bleeding, if the bleeding cannot be stopped, again to save the patient’s life
It should be known that the uterus can be removed.
In patients with placenta increata and percreata, the only treatment option is hysterectomy.
removal of the placenta) The risk of complications is even higher when the placenta has advanced outside the uterus
will be high. In such operations, it is recommended to use a bladder (urinary bladder) and ureter
urologist, an anesthesiologist experienced in acute blood loss, and an obstetrician and gynecologist.
will perform the surgery as a team.

Why are placenta acreata, increata and percreata surgeries risky?
Especially those that cannot be diagnosed before birth due to the very high risk of bleeding.
patients are at risk of maternal and infant death due to blood loss. Blood transfusion related
reactions may occur. In cases where the placenta is outside the uterus due to adhesions
neighboring organs (bladder, ureter, intestines) may be injured. Hence placenta acreata,
It is extremely important that an experienced surgeon performs increata and percreata surgeries.