A 32-year-old G3P2 with two previous cesarean sections delivers at 38 weeks by repeat cesarean. The placenta fails to separate after 30 minutes of controlled cord traction. On attempting manual removal, the myometrium tears with the placenta. Histopathology of the excised uterus shows absence of the decidua basalis with chorionic villi directly adherent to myometrial fibers. What is this condition, and what is the classification?
- A Placenta increta (deep myometrial invasion), characterized by villi penetrating into but not through myometrium
- B Placenta percreta (full-thickness invasion), characterized by invasion through serosa
- C Placenta accreta (superficial invasion), which is the mildest form on the accreta spectrum ✓
- D Placenta previa with abnormal implantation
Explanation
Histopathological absence of decidua basalis with chorionic villi directly adherent to (but not invading) myometrial fibers defines placenta accreta (also called creta vera), the mildest and most common form of placenta accreta spectrum (PAS). In placenta increta, villi penetrate into the myometrium; in placenta percreta, villi penetrate through the full thickness of myometrium to serosa and may invade adjacent organs. The PAS classification uses these three histological grades. Risk factors include prior uterine surgery, particularly uterine scars from cesarean delivery, and low-lying placenta. Management involves planned hysterectomy or uterine conservation with leaving the placenta in situ.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.