A 30-year-old woman with two prior caesarean sections delivers at 38 weeks. On manual placenta removal, a portion of placenta is found adherent and cannot be separated. On histology, chorionic villi are found invading through the decidua and the full myometrium reaching the uterine serosa. This represents which grade of morbidly adherent placenta?
- A Placenta accreta
- B Placenta increta
- C Placenta percreta ✓
- D Placenta praevia with accretism
Correct answer: C. Placenta percreta
Explanation
In placenta percreta (the most severe form), villi penetrate the entire myometrium and reach the uterine serosa, and may invade adjacent organs (bladder, bowel). Placenta accreta (most common, ~80%) refers to villi that adhere to myometrium without penetration. Placenta increta (~15%) invades into the myometrium. Percreta (~5%) penetrates through the serosa. Risk factors include prior uterine surgery, especially in the setting of placenta praevia, and the combination of anterior praevia with prior caesarean carries a >60% risk of accreta spectrum disorder.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.