Placenta Percreta

Definition - What does Placenta Percreta mean?

Placenta percreta is a type of placental abnormality in which the placenta invades the full thickness of the uterine muscle and sometimes even penetrates adjacent organs such as the bladder or the rectum. It is a very rare and the most extreme form of placenta accreta, a condition in which the placenta adheres itself superficially to the uterine muscle. Placenta percreta accounts for approximately 5% of pregnancies. It is a potentially life-threatening condition due to the risk of bleeding into the bladder. In addition, deep invasion of the uterine cavity puts it at risk of massive bleeding both during and after delivery. This warrants surgical removal of the uterus, which negatively impacts fertility.

FertilitySmarts explains Placenta Percreta

Normally, the placenta attaches to the uterine wall. However, some factors may cause it to penetrate the outer wall of the uterus and adhere too deep into the uterine muscle.

Various factors can trigger placenta percreta such as:

  • A uterine scar from a previous cesarean delivery
  • Placenta previa, which is an abnormally low-lying placenta
  • Having had five or more previous pregnancies
  • Formerly treated Asherman syndrome, which is a condition in which scars develop within the uterus
  • Previous uterine curettage or scraping

A woman with placenta percreta is likely to experience the following symptoms:

  • Painful vaginal bleeding owing to the penetration of the bleeding placental tissue into the wall of the uterus
  • A dull lower abdominal pain throughout pregnancy
  • Passing blood in urine when the placenta percreta invades the bladder

In women suspected of having placenta percreta, the doctor will likely perform an ultrasound, cystoscopy, and MRI (if needed). The ultrasound scan will show a low-lying uterine sac with a thin uterine muscular wall, and an irregular line between the bladder and uterine muscle. Cystoscopy (examination of the bladder with the help of a tube with and an attached camera) may often reveal abnormalities in the bladder wall. The condition, however, is usually detected at the time of delivery.

The placenta percreta is not removed manually as this could precipitate massive uterine bleeding. Instead, after controlling the bleeding from the retained placenta percreta, the doctor may use a medicine called methotrexate with a goal to destroy all viable products of conception.

The retained portion of the placenta can otherwise cause uncontrolled uterine bleeding following delivery. This warrants surgical removal of the entire uterus (hysterectomy). Undergoing a hysterectomy has a negative impact on the childbearing-bearing potential of a woman.

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