The Management and Outcomes of Placental Adhesion

Abstract

Placenta adhesion, often involving placenta accreta, placenta increta, and placenta percreta, is a clinical term used to describe placenta that does not separate spontaneously and cannot be removed without causing abnormally high blood loss. Prior cesarean section, other uterine surgery, assisted reproduction techniques and placenta previa are all risk factors for placental adhesion and their prevalence has increased steadily. Maternal mortality and morbidity are reduced when accurate prenatal diagnosis of placental adhesion is made. Currently, grayscale ultrasonography, with or without color Doppler has been used widely. However, the performance of these markers shows considerable variability and most of findings are poorly defined. The standardized ultrasonography description should always be reported when performing an ultrasonography scan for suspected placental adhesion to advance diagnosis and treatment. When suspicious findings are identified preoperatively, management should be tailored accordingly. The location and timing of delivery, access to a multidisciplinary care team, availability of the appropriate surgical approach, and access adjunctive techniques are key issues. In conclusion, placental adhesion is a clinically relevant, difficult-to-manage problem with rising incidence worldwide. Tertiary care hospital with an experienced optimum management should be considered and the basis for appropriate risk assessment and delivery planning improves maternal outcome.