Argentina has a special characteristic, unusual in other countries: a significant number of newborns, together with a high percentage of cesarean sections, facts closely associated with the occurrence of this disorder. Our team has worked for years on the setting of new behavior and treatment guidelines which developed countries have not been able to assimilate yet. This experience has been published on international medical journals and lectured at first-class academic centers, such as Harvard and Georgetown Universities, in the United States.

Research into all the aspect related to diagnosis and treatment of placental adherential disorders has led to original advances worldwide, such as one-step surgery. In this procedure, invasion, hemorrhage, and the possibility of recurrence are solved in a single surgical act. Given its innovative features, this surgery was included in the prestigious 2006 Year Book of Obstetrics and Women’s Health, published by Mosby-Elsevier, one of the most renowned medical publishers in the US and Europe.

A multicentric study is being carried out with France and Belgium in order to determine the cause of this type of abnormal adherential disorder, and the way to prevent it in the future. Nowadays, there is growing awareness from developed countries, since the increased frequency of cesarean section on patient’s demand, which leads to this type of disorder.

The information given so far places this center as an integral team committed to providing the best health care available. For this reason, we avoid using rigid treatment schemes, and we consider the alternatives and resources according to each particular case. Our goal is that you receive expert, safe and responsible treatment, while we protect the highest standard of care. In addition, we commit ourselves to using all the necessary resources in order to repair and preserve your genital system, provided that it is technically safe, in order to preserve your fertility.

 

What is placenta accreta or abnormally adhered placenta?

Abnormally adhered placenta refers to the placenta that has firmly fixed to the uterine muscle, which hinders its expulsion after vaginal delivery or cesarean section.

Is this type of placenta frequent?

Until 1960, few cases were reported. However, with the increase in the rates of cesarean section, this entity has become more frequent.

What is the risk that this type of placenta implies?

The most common danger is maternal hemorrhage. Due to the high uterine blood flow to the placenta, this type of hemorrhage is usually severe, and unless efficient and immediate treatment is provided, it can also be life-threatening.

Does uterine removal always solve this type of bleeding?

Although uterine removal (hysterectomy) is the most widely used treatment for this type of disorder, this procedure does not always solve the hemorrhage, since there may be other organs involved. Moreover, during uterine removal, maternal coagulation may be severely altered.

Are placenta accreta, increta or percreta synonyms?

Although the placentas may coexist, these terms indicate the degree of placental penetration into or outside the uterine muscle. Placenta percreta presents the highest degree of placental penetration or invasion.

Why do I have this type of adherent placenta?

The main risk factor for this type of placenta is previous uterine surgeries, the most common of which is iterative cesarean section. Other risk factors are abortions or evacuating uterine D&C.

How can I know if I have placenta accreta, percreta or adherent placenta?

The obstetrician is the one who will have the first suspicion in case of placenta previa or anterior placenta in women with previous cesarean sections. Special attention must be given to these cases, so as to request other confirmatory methods.

I have placenta previa and had previous cesarean deliveries. My ultrasonography was uneventful. Is there anything to worry about?

Ultrasonography for the diagnosis of adherent placenta must be done by a professional used to recognize the signs proper of this pathology. Otherwise, this entity can go completely unnoticed.

Is placental magnetic resonance imaging (pMRI) better than ultrasonography for the diagnosis abnormal adherence of the placenta?

No, it is not. Ultrasonography done by an expert operator has almost 90% diagnostic accuracy for adherent placenta. MRI determines invasion site, and the possibility of both intrasurgical events and uterine preservation.

Does pMRI imply any risk for my baby?

No. There is no potential risk for or damage to the baby.

If I have an abnormally adhered placenta, is it necessary to anticipate the cesarean section?

It depends on the degree of invasion and on certain clinical and obstetric factors. However, cesarean section is usually performed at 35-38 week gestation.

What are the treatment alternatives for this type of abnormal adherence?

Basically, there are two types of surgery. On the one hand, there is the surgery that removes the uterus and, on the other, uterine preservation procedures.

What do preservation procedures consist of?

Preservation procedures allow delivery of the baby and uterine preservation for further pregnancies, if desired. In our section, placental removal, diseased tissue removal and uterine repair are performed in one surgical act.

In case of undergoing preservation treatment, is it feasible to get pregnant again with no risk of further abnormal adherence?

In Europe, the treatment that consists in leaving the placenta in situ is frequently used, and reabsorption is expected within weeks or months. However, this procedure implies a high rate of recurrence in subsequent pregnancies. On the contrary, in our section we perform diseased tissue resection and uterine reconstruction, thus avoiding recurrence. To date, 41 cesarean sections with no complications have been performed in pregnancies developed after reconstructions due to placenta percreta.

What is uterine artery embolization? Can this procedure solve my problem?

Uterine embolization is the occlusion of the arteries irrigating the uterus through a 1-2 mm catheter placed by puncture of the groin artery. This procedure aims to reduce bleeding in abnormal placentation as well as in other obstetric hemorrhages. This is an auxiliary treatment, since it only deals with part of the problem, the hemorrhage. Two ways of work can be applied in this regard. First, catheters can be placed at the radiology service one hour before surgery. The other is only taken in case hemorrhage cannot be efficiently stopped.

In case of one-step surgery, is the postoperative period very long?

No, it is not. A series of check-ups should be done during the first 24-48 h, which is associated with changes in coagulation. A special regimen of postoperative analgesia should also be carried out. The postoperative period is usually similar to that of a normal cesarean section.