Massive Adherent Placenta, Placenta Percreta

Abstract

Background: Adherent placentas including placenta accreta, increta and percreta are conditions where there is abnormal implantation of all or part of the placenta on the myometrial wall. Massive adherent placenta has high morbidity and mortality rates in both mother and fetus. There is a positive correlation between the incidence of adherent placenta and the increase in cesarean section rates worldwide. Identification of risk factors, antenatal diagnosis, accurate preoperative preparation, multidisciplinary management, and appropriate counseling are the main management of adherent placenta to reduce maternal morbidity. Case Presentation: A woman, G5P3A1, age 36 years pregnant 37 weeks, complained loudly regularly since 6 hours before admission to hospital. There is a history of CS as much as 3x with indications of 2x Premature rupture of the membranes and uterine rupture, as well as a history of curettage (1x). Physical examination showed that the general condition was good, and composting, vital signs were within normal limits. Abdomen palpable single fetus, intrauterine, elongated, head presentation, left back, moderate his (+), FHR 150 x/minute. The results of prenatal sonography examination showed that neither placenta previa nor massive adherent placenta was found. The preoperative diagnosis was inparticular stage I latent phase with a history of SC 3 times. Results: An emergency Caesarean section was performed. Durante surgery showed severe adhesions of the placenta, uterine wall and bladder. The diagnosis of placenta percreta was confirmed, uterine resection was performed on the perreta section, hysterography as well as adhesiolysis and MOW sterilization. The results of the PA examination support the diagnosis of placenta percreta. Conclusion: Massive adherent placenta, placenta percreta was not diagnosed in this case because there were no clinical features or prenatal sonography that supported the diagnosis of placenta percreta. A history of trauma to the uterus due to uterine rupture, history of CS and curettage were risk factors for placenta percreta in this case. The incidence rate of placenta percreta with a history of SC 3 times without placenta previa on the previous sonographic examination was 0.1%. Operative management to manage bleeding and post operative care have been carried out according to the procedure so as to avoid mortality. Keywords: massive adherent placenta, placenta percreta, case report Correspondence: Eric Edwin Yuliantara. Department Obstetrics and Gynecology, Faculty of Medicine Universitas Sebelas Maret/ dr. Moewardi General Hospital Surakarta. Jl Kolonel Sutarto 132, Surakarta, Central Java. Email: edwinericog- @staff.uns.ac.id. Mobile: 08122618769.

Early Detection and Good Team Collaboration for Preventing Maternal Death Caused by Placenta Accreta Spectrum Disorder

“…Placenta accreta spectrum (PAS) is the modern term for a group of clinical pregnancy problems caused by different combinations of abnormal placental implantation and a uterine wall defect [2] . Placenta accreta occurs when implantation is abnormal and the placenta grows too deeply into the myometrium, tunica serosa, and organs surrounding the uterus [1,2] . The pathologic invasiveness of the placenta is classified into three categories: placenta accreta (anchoring villi cling to the surface myometrium without interposing decidua), placenta increta (placental villi penetrate into the myometrium), and placenta percreta (anchoring villous tissue penetrates through the entire uterine wall even to the surrounding organs) [7,8] .…”

“…Placenta accreta spectrum (PAS) is the contemporary nomenclature for a set of clinical pregnancy issues caused by a combination of abnormal placental implantation and a uterine wall defect [1,2] .…”