Placenta Accreta...

When I was orienting to L&D last summer we had a patient who had a complete previa & percreta. we had her for awhile antenatally then she had a scheduled section/hyster at ??34 or 35 weeks (I don't remember exactly). Also a couple weeks ago we had a patient who delivered lady partslly but then bled and bled and the MD suspected an accreta. She did stabilize after like a zillion mcg of misoprostol rectally.

Last time I saw an accreta the OB tried to manage it during post-partum with some chemotherapeutic agent...methotrexate, I believe. Unfortunately, it didn't work out as he had hoped and the patient started bleeding and ended up with a hysterectomy.

At a conference last year I heard of one place actually leaving the placenta in to reabsorb. Can't remember for the life of me where they did this but it did work. I think it was in another country...

We lost a mom a couple of years ago that had acreta. They didn't know antenatally. She went for a scheduled repeat c/s and it had grown our through the uterus and into her internal organs. A hys wasn't enough. She was in the OR for hours with other surgeons going in and A LOT of blood given. It was HORRIBLE! Her other children were older and had walked her into the OR. The baby did great, but it was really tragic.

At a conference last year I heard of one place actually leaving the placenta in to reabsorb. Can't remember for the life of me where they did this but it did work. I think it was in another country...

I can't imagine that they would have done that without the use of a chemotherapeutic agent like methotrexate (like a PP mentioned).

I've seen two in my short OB career. First one, G3P1--hx nsvd 10yrs ago--the mother was about 9 weeks along and the IUP spontaneously demised (which was good, because they would have had to TOP otherwise), and the docs tried about 4 rounds of Mtx IM, plus 6 transfusions PRBC and whole blood. The whole ordeal lasted over a month.

The second was a G2P1 hx of c/s 2 years ago. The placenta attached right below the c/s scar tissue and (the docs believe) because it couldn't advance upwards due to decreased vascularity, it became a complete previa. Her doc realized she was a potential Code Noelle, and they c/sed her in the Main OR with 4 units on hold the 4 weeks she was in the ante unit.

Both ended up with hysterectomies. :uhoh21:

Kelly

could be they did. I don't remember the details of it all...

Here is a good article that explains the basics.

"The placenta normally attaches to the uterine wall, however there is a condition that occurs where the placenta attaches itself too deeply into the wall of the uterus. This condition is known as placenta accreta, placenta increta, or placenta percreta depending on the severity and deepness of the placenta attachment. Approximately 1 in 2,500 pregnancies experience placenta accreta, increta or percreta."

http://www.americanpregnancy.org/pregnancycomplications/placentaaccreta.html

These are undoubtedly some of the scariest OB conditions you can run into. There is no way to prevent hyperimplantation (although previous c/s scarring appears to be a risk factor) and little that can be done to treat it once discovered. Although the ovaries usually are left intact, only rarely can the utuerus be saved and that usually with a struggle.

The other frightening thing about this is that by the time symptoms appear and diagnostic tools can identify the problem, the damage is already advanced.

On the plus side, there are miracles. Saw a program last week about a child who was an ectopic pregnancy carried to term. Mom had excruciating pain off and on for six months, but ultrasounds appeared normal. They didn't show that the child was next to the uterus, not inside it. The placenta had implanted on mom's internal organs and none of this was apparent until the OB decided to do a section for labor that had failed to progress--uh, yeah, that would be a problem. Somehow both mother and child survived. The kid is now five or six years old and is doing beautifully. Mom, too.

Had a friend who lost her uterus and nearly her life due to a bad increta (like an accreta but deeper).

I told this story here a while back (she had a NDE that stood my hair on end)

VERY SERIOUS if not caught early-on and almost always results in need for a hyst afterward.

What do you mean if not caught early on? I didn;t think there was any treatment possible??? ps, whats an NDE?

What do you mean if not caught early on? I didn;t think there was any treatment possible??? ps, whats an NDE?

Can be treated with methotrexate, as mentioned by myself and another poster (or two?).

If caught *very* early on, can be manually w/a D&C. But we're talking like, in the 1st days/weeks of the accreta. Very rare to catch it that early, because it can be hard to distinguish between normal vascularity and the beginings of the increased vascularity associated with accreta.

NDE usually means "near death experience," and that would definitely fit with what Deb was talking about.

yes she coded in the OR and "died"....and remembers some really scary stuff. she "chose" to come back. And I believe her.