percreta

Placenta percreta is the most severe form of the placenta accreta spectrum, in which placental villous tissue invades through the myometrium and serosa and can extend into adjacent structures such as the urinary bladder or broad ligaments. It commonly occurs in pregnancies with placenta previa and a history of uterine surgery, particularly prior cesarean deliveries. Other risk factors include multiple prior pregnancies, advanced maternal age, and uterine abnormalities.

Diagnosis is typically considered when risk factors are present. Prenatal imaging relies on ultrasound with color Doppler to identify signs such as placental lacunae, thinning or disruption of the myometrium, an irregular placental-myometrial interface, and placental tissue extending toward or beyond the uterine serosa. Magnetic resonance imaging can be used as an adjunct to delineate invasion and involvement of adjacent organs. Prenatal identification enables planning for delivery in a specialized center.

Management usually involves delivery with a planned cesarean hysterectomy in a setting equipped for massive obstetric hemorrhage and multidisciplinary care. Timing is individualized, often in the late third trimester, with preparations for significant blood loss and potential injury to nearby organs. Conservative management, such as leaving placental tissue in place, has been described in select cases but carries risks of hemorrhage, infection, and subsequent procedures, and is generally reserved for carefully selected patients.

Outcomes relate to substantial maternal morbidity, including severe bleeding and transfusion needs, as well as risks associated with prematurity for the neonate. Prognosis depends on the extent of invasion, the presence of placenta previa, and the timeliness and quality of neonatal and obstetric care.