Placenta accreta, increta and percreta cause a significant risk for

hemorrhage, maternal morbidity and mortality. Care coordination

and advance planning, availability of blood products, and

interdisciplinary resources are essential to mitigate this risk.

Statement of the Problem

Background

The Society of Maternal Fetal Medicine states that “the reported

incidence of accreta has increased from 0.8 per 1000 deliveries in

the 1980s to 3 per 1000 deliveries in the past decade.”

Placenta previa in the presence of prior cesarean section or uterine

scare is a significant risk factor for development of placenta

accreta.

The FIGO Placenta Accreta Diagnosis and Management Expert

Consensus Panel state that the increase in placenta accreta is a

consequence of the rise of cesarean sections over the last two

decades.

SMFM & ACOG Guidelines for Placenta Accreta

spectrum

Placenta Accreta: Mitigating Risk with CNS Lead Multidisciplinary Team Coordination

Jamie Vincent, APRN-CNS, RNC-OB, C-EFM, Perinatal Clinical Nurse Specialist

Strategy and Implementation

Evaluation

Quality & Process Improvement

References

Perinatal Morbidity and Mortality reviews

Quarterly auditing and quality & process improvement action plans

Hung, T.H., Shau, W.Y., Hsieh, C.C., Chiu, T.H., Hsu, J.J., and

Hsieh, T.T. Risk factors for placenta accreta. Obstet Gynecol. 1999;

93: 545–550 (Case-control level II-2)

Jauniaux, E., Chantraine, F., Silver, R.M., Langhoff-Roos, J. (2018).

FIGO consensus guidelines on placenta accreta spectrum

disorders: Epidemiology. International Journal of Gynecology and

Obstretrics.:140: 265-273.

Silver, R. M. & Branch, D. W. (2018). Placenta Accreta Spectrum.

New England Journal of Medicine. 378: 1529-1536.

Society of Maternal Fetal Medicine (SMFM). (2010). SMFM Clinical

Opinion Placenta Accreta. American Journal of Obstetrics and

Gynecology. November 2010. pp. 430-439.

Normal Placenta Placenta Accreta

https://www.nejm.org/doi/suppl/10.1056/NEJMcp1709324/suppl_file/nejmcp1709324_appendix.pdf

https://www.nejm.org/doi/full/10.1056/NEJMcp1709324#section_key_clinical_points

https://www.nejm.org/doi/full/10.1056/NEJMcp1709324#section_key_clinical_points

Uterus Post-hysterectomy:

Placenta In situ:

Classical Fundal incision is closed

Placenta is bulging the lower uterine segment

Increased vascularity is evident

The placenta is almost visible through the lower uterine segment, and there is evidence of increased vascularity.

The fetus has been delivered through a fundal uterine incision, which has been repaired.