PATHOLOGICAL ADHERENCE OF PLACENTA - CASE REPORTS

Major obstetric hemorrhage is the leading cause of maternal morbidity and mortality. In rare cases, life-threatening hemorrhage in pregnant women may result from abnormal adherence of placenta. Three grades of abnormal placental attachment are defined according to the depth of invasion: placenta accreta, placenta increta, and placenta percreta. An important risk factor for placenta abnormal adherence of placenta is placenta previa in the presence of a uterine scar. The increased prevalence of cesarean section, uterine surgery, and increasing parturient age and parity have led to an increased incidence of abnormal placentation, from one in 2,500 a quarter century ago, to one in 533 deliveries currently. Placenta percreta significantly increases risk for both maternal and fetal morbidity and mortality. Placental invasion of the bladder carries a maternal morbidity of 9.5% and perinatal mortality of 24%. Prevention of the maternal death in the condition when the patients have uterine scarring or a history of other invasive procedures may be improved by the adequate preoperative diagnostics of these conditions. When it involves the urinary bladder, a multidisciplinary approach utilizing a team of physicians and surgeons representing urology, radiology, and obstetrics-gynecology is the key to successful management.