• Vol. 36 No. 4, 298–303
  • 15 April 2007

Lessons Learnt from Two Women with Morbidly Adherent Placentas and a Review of Literature

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ABSTRACT

Introduction: Pathologically adherent placentas occur when there is a defect of the decidua basalis, typically arising from previous caesarean section, resulting in abnormally invasive implantation of the placenta. The depth of placental invasion varies from the superficial (accreta), to transmural and possibly beyond (percreta). Clinical Picture: We report on 2 cases, one treated “conservatively”, the other with a caesarean hysterectomy, both of which led to a safe outcome for both mother and baby. Conclusions: Management relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric haemorrhage at delivery.


Pathologically adherent placenta occurs when there is a defect of the decidua basalis, resulting in abnormally invasive implantation of the placenta into the substance of the uterus. As a result, there is no clear plane between the placenta and the underlying uterus to which it is implanted. The extent of adherence and invasion of the placenta varies from the superficial (accreta), into the myometrium (increta) and right through the myometrium to breach the serosa or beyond (percreta), involving adjacent structures such as the bladder. The principal risk for this condition is massive obstetric haemorrhage at delivery, particularly when attempts are made to separate the placenta in unrecognised cases.

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