الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 108 |  |  |
| | | from | 108 | | |
Abstract
Placenta accreta is the placenta that is abnormally adherent to the uterus, is thought to be due to an absence or deficiency of Nitabuch’s layer or the spongiosus layer of the deciduas. This becomes a problem at delivery when the placenta does not separate and massive bleeding occurs.
The rising incidence of placenta accreta is due to the rapidly rising numbers of primary and repeat cesarean births, the overall incidence of placenta accreta is 1 in Every 533 deliveries.
Risk factors for placenta accreta include placenta previa with or without previous uterine surgery, prior cesarean delivery, Asherman’s syndrome, submucous leiomyomata, and maternal age older than 35 years.
Prenatal diagnosis seems to be a key factor. Sonographic features of placenta accreta include placenta praevia, placental lacunae, loss of the normal retro placental clear space, anomalies of the bladder/myometrium interface, and abnormal color Doppler imaging patterns.
Two strategies for the management of placenta accreta have been described: surgical removal of the uterus and conservative management. The current trend is of uterine conservation and leaving the adherent placenta in-situ with adjuvant treatment with Methotrexate. These strategies have been employed in order to avoid peripartum hysterectomy and to preserve fertility. Such techniques may be appropriate as long as bleeding remains minimal. Successful conservative treatment may appear not to compromise the patients ’subsequent fertility or obstetrical outcome.
The key to the success of nonsurgical intervention rests largely on early diagnosis or, more accurately, on early suspicion of placenta accreta, so that, management strategies can be planned and discussed. The main elements of successful conservative management are leaving the placenta undisturbed.