[khanar]

After normal vaginal delivery of 36 week gestational age baby the placenta was not being removed easily as it is attached to the uterine wall. Bleeding was excessive and so emergency hysterectomy was performed. Placental membranes are found to be superficially invading the myometrium. Which of the following is the most likely diagnosis?

A- Placenta previa
B- Placenta percreta
C- Placenta accreta
D- Placental infarction
E- Abruptio placentae

 

[ath.pantelis]

ACcreta--> ATtaches firmly to the endometrium and superficially to the myometrium, without invading the myometrium to its full thickness.

INcreta--> INvades the full thickness of the myometrium.

PERcreta--> PEnetrates the myometrium and invades a neighboring viscus (eg bladder).

Previa--> placenta is found near the os of the uterus and my obliterate it in different grades (low lying < marginal < partial < complete).

Abruptio placenta happens before the onset of parturition and it actually describes any condition that causes abrupt detachment of the placenta from the uterine lining. Always consider it in a clinical vignette describing a pregnant women in trauma setting, due to severe deceleration. Potentially threatening if hemorrhage is abundant, but don't be mislead! Sometimes the blood may accumulate in a potential empty-space layer between the uterine lining and the placenta and thus not be evident as vaginal bleeding! USMLE examiners love this one!