ISSN: 2044-9038 (Print) 2044-9046 (Electronic)

Clinical Practice

Abnormal Placental Invasion

Abnormal placental invasion is abnormal adherence of the placenta, either in whole or in part, to the underlying uterine wall. Based on histopathology, it is divided into three grades: placenta accreta (the chorionic villi are in contact with the myometrium), placenta increta (the chorionic villi invade into the myometrium) and placenta percreta (the chorionic villi penetrate the uterine serosa and occasionally invade into adjacent organs). The incidence of abnormal placental invasion has increased 10-fold in the past 50 years, reflecting the increased number of cesarean sections performed. Management relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric hemorrhage at delivery. Women at risk should plan to deliver at an institution with appropriate expertise and resources for managing this condition. We report a case of placenta increta management comprising preoperative placement of a pelvic artery balloon catheter, prophylactic balloon occlusion after delivery of the fetus, and embolization-assisted resection of the invaded uterine wall. We review incidence, methods of prenatal diagnosis, risk factors, and management of abnormally invasive placenta. After completion of this educational activity, the participant should be better able to recall risk factors for abnormal placental invasion, explain the diagnostic choices for identifying abnormal placental invasion, and prepare a logical treatment plan for the woman with abnormal placental invasion.    

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