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1.

Placenta Accreta – the placental chorionic


will adhere to the superficial layer of the
uterine myometrium.

2. Placenta Increta – the placental chorionic


will invade deeply into the uterine
myometrium.

3. Placenta Percreta – the placental chorionic


will go through the uterine myometrium
and often adhere to abdominal structures
such as the bladder or intestine
History of previous uterine
surgery; such as
Cesarean delivery (risk increases
with each subsequent cesarean
section)
Myomectomy
Dilatation and Curettage
Other risk factors include;
Age older than 35
Placenta previa
Maternal Implications:
interferes with normal placental separation
in the 3rd stage of labor, resulting in
hemorrhage, which may require
hysterectomy to control. May also cause
uterine rupture during pregnancy or labor.
 
Fetal Implications:
Fetal death may occur if the condition
results in uterine rupture
Etiology:
Predisposing factors are prior uterine surgery
and placenta previa

Pathophysiology:
Implantation in an area of defective
endometrium with no zone separation
between the placenta and the myometrium.
Incidence: 1 and 2500 pregnancies 
Mortality rate: as high as 10% with
percreta
Signs and Symptoms:
 There are no apparent symptoms

Diagnosis:
 -Ultrasound
› loss of the normal hypoechogenic zone between the
placenta and myometrium
abnormality of the smooth interface between the
uterus and bladder a Swiss- cheese appearance to
the placenta, with hypoechogenic spaces within
pulsatile flow of the maternal blood into the
hypoechogenic spaces.
 -MRI
ASSESSMENT
 Associated findings. Placenta accreta is
usually diagnosed in the immediate
postpartum period when the placenta
fails to separate.
 Clinical manifestations
a. Placenta fails to separate
b. Profuse hemorrhage may result
depending on the portion of placenta
involved.
Diagnosis
 -risk for infection related to excessive
blood loss/ exposed placental
attachment site.
 -risk for injury related to attempted
manual removal of retained placenta

Planning
 -reduce hemorrhage
 -to maintain normal v/s and lab.values
Interventions
Pharmacologic : Non-Pharmacologic :
-methotrexate -witch Hazel
-oxytocin -lady’s mantle
-analgesia -cotton root bark
-Identify placenta accreta in the
client. Be aware of the client’s risk
status.
- Assist with rapid treatment and
intervention. Be prepared for a
dilation and curettage or
hysterectomy.
- Provide physical and emotional
support.
- Provide client and family
education.
 
Witch - hazel Lady’s mantle

Cotton root bark


Evaluation
 Was able to :
› Reduce hemorrhage
› Maintain normal vital signs and lab.
values