What are the complications of a deeply implanted placenta?

Hello,

Welcome to icliniq.com.

I am deeply concerned about your worries.

When the placenta is deeply implanted, it is not a good sign, and it is called placenta previa, increta, or percreta. There are four types:

1. Type 1: When the placenta is in the lower uterine segment (less than 20 mm from the internal os) but does not reach the internal os.
2. Type 2: When the placenta is in the lower uterine segment and reaches the internal os.
3. Type 3: When the placenta partially covers the internal os.
4. Type 4: When the placenta completely covers the internal os.

Incidence:

1. Placenta previa: 0.4 to 0.8 percent at term, 3 percent at 28 weeks.
2. Placenta accreta: 80 percent.
3. Placenta abruption: 5 percent.

Risk factors for placenta previa are:

1. Multiparity.
2. Uterine curettage.
3. Manual removal of the placenta.
4. IVF (in vitro fertilization).
5. Multiple pregnancies.
6. Fibroid uterus.
7. Previous history of placenta previa.

Relation with previous C-sections:

1. Zero C-sections: 3 percent.
2. One C-section: 11 percent.
3. Two C-sections: 40 percent.
4. Three C-sections: 61 percent.
5. Four C-sections: 67 percent.

The black spots could possibly be blood clots; however, there is no need to worry if the fetal heart rate, amniotic fluid, and estimated fetal weight are normal.

I suggest you undergo a few investigations:

1. Blood group and Rh factor.
2. Complete blood count (hemoglobin should be maintained above 11g/dl).
3. Fasting blood sugar.
4. Urinalysis.
5. Viral markers.
6. Ultrasound.
7. Repeat obstetric ultrasound by a senior sonographer.

NPSA (National Patient Safety Agency) provides a care bundle for placenta previa. Delivery should be done in a tertiary care hospital where the MDT (multidisciplinary team) is available. Consultant obstetrician, consultant anesthetist, and consultant hematologist should be available. Blood and blood products should be arranged.

The hospital should have a level 2 ICU. Bed rest is recommended. Stop doing daily activities at home. You should have someone with you at all times. In case of any per vaginal bleeding, you should reach the hospital within 15 minutes. This is a high-risk pregnancy. You must understand the condition and follow the instructions.

I hope I have made it clear to you.

If you have any further queries, please do not hesitate to ask me.

Thank you.

Hello,

Welcome back to icliniq.com.

The picture (attachments removed to protect the patient’s identity) you sent does not show signs of placenta accreta, which can present with the following:

1. Loss of the clear zone.
2. Abnormal placental lacunae.
3. Bladder wall interruption.
4. Myometrial thinning.
5. Placental bulge.

However, if the consultant radiologist has observed the placenta implanted in the lower segment, your case may be considered placenta accreta.

I would like to know more about your history:

1. How many years have you been married?
2. Gravida and parity?
3. Date of your last childbirth?
4. Date of your last menstrual bleeding?
5. Duration of your previous delivery?
6. Expected date of delivery?
7. What was the mode of your previous delivery? Normal vaginal delivery or C-section? If a C-section was performed, how many have you had?

I would appreciate it if you could respond to all these questions.

Thank you.