PLACENTA ACCRETA

Placenta accreta is an extremely rare form in which the placenta is directly anchored to the myometrium partially or completely without any intervening decidua. The probable cause is due to absence of decidua basalis and poor development of fibrinoid layer. Overall incidence of placenta accreta or its variations is 1 in 550 deliveries.

Risk factors for placenta accreta: Most important are the placenta previa and prior cesarean delivery. Other risk factors include prior uterine surgery (dilatation and curettage, manual removal of placenta, synaecolysis or myomectomy) increasing maternal age and parity.

The risk of placenta accreta with placenta previa in an unscarred uterus is about 3%. The risk rises sharply with increasing number of cesarean delivery. Placenta previa with one prior cesarean section, the risk of being accreta is about 11%, whereas with two it is 40% and it is 67% with four or more cesarean sections.

The diagnosis is made only during attempted manual removal when the plane of cleavage between the placenta and the uterine wall cannot be made out. Ultrasound imaging, color Doppler and MRI

have all been valuable in the diagnosis of placenta accreta, increta and percreta during pregnancy. USG findings suggestive of placenta accreta are:

i) Loss of normal hypoechoic retroplacental myometrial zone

ii) Thinning and disruption of the uterine serosa-bladder interface and focal exophytic masses invading the bladder. Color flow Doppler study shows hypervascularity of serosa bladder interface.

MRI reveals detour vessels and dark intraplacental bands on T2-weighted imaging. Unexplained rise of maternal serum αFP is observed with placenta accreta. Pathological confirmation includes-

a) Absence of decidua basalis,

b) Absence of Nitabuch’s fibrinoid layer and

c) Varying degree of penetration of the villi into the muscle bundles (increta) or up to the serosal layer (percreta). The risks include hemorrhage, shock, infection and rarely placenta accreta.

HOMOEOPATHIC MEDICINES FOR MANAGING PLACENTAL COMPLICATIONS: -

There are many Homoeopathic remedies which can manage such conditions very effectively.

 Belladonna, Caulophyllum, Cantharis, Cimicifuga, Pulsatilla, Secale, Sepia.