Clinical features and diagnosis of the morbidly adherent placenta (placenta accreta, increta, and percreta)
- Robert Resnik, MD
Robert Resnik, MD
- Professor of Reproductive Medicine
- UCSD School of Medicine
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
Morbidly adherent placenta is a general term that includes placenta accreta, increta, and percreta. The clinical features and diagnosis of the three types of morbidly adherent placenta have many similarities. Therefore, unless otherwise noted, the following discussion of placenta accreta applies to all depths of placental invasion.
This topic will discuss the clinical features and diagnosis of the morbidly adherent placenta. Management of patients with a morbidly adherent placenta is reviewed separately. (See "Management of the morbidly adherent placenta (placenta accreta, increta, and percreta)".)
Placenta accreta refers to an abnormality of placental implantation in which the anchoring placental villi attach to myometrium rather than decidua, resulting in a morbidly adherent placenta.
Placenta increta (chorionic villi penetrate into the myometrium) and placenta percreta (chorionic villi penetrate through the myometrium to the uterine serosa or adjacent organs) are related, but more severe, abnormalities of placental implantation. The pathogenesis is primarily attributed to defective decidualization of the implantation site .
Placenta accreta is much more common than placenta increta and percreta. In a pooled analysis of results from two series involving a total of 138 histologically confirmed, abnormally implanted placentas from hysterectomy specimens, the type and frequency of abnormal placentation were [2,3]:
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- CLINICAL FEATURES
- Risk factors
- Clinical presentation
- - Ultrasonography
- Color Doppler
- Three-dimensional ultrasound
- - Magnetic resonance imaging
- Laboratory findings
- - Elevated maternal serum alpha-fetoprotein
- - Hematuria
- Diagnostic approach
- SUMMARY AND RECOMMENDATIONS