April 26th, 2018

Do Placentas from Hysterectomies Performed for Placenta Accreta Show Adherent Muscle?
Authors:  D. S. Heller, M.D.
  To the Editors:
Placenta accreta is the abnormal adherence of the placenta to the uterus after delivery of the infant, due to deficiency of the decidua basalis. It may be total or partial. It is becoming more common as more cesarean deliveries are being performed. It is a cause of postpartum hemorrhage, and often hysterectomy. It has been suggested that the diagnosis can be supported by examining the placenta microscopically for adherent smooth muscle as opposed to examining a hysterectomy specimen for adherent placenta, although the finding may not confirm a clinical diagnosis of accreta.1 Identification of adherent muscle at the basal plate of the placenta would allow for diagnosis in cases for which hysterectomy has not been performed, often subclinical cases. This may be useful knowledge for subsequent pregnancies, where predelivery anticipation of recurrent, and possibly more severe, accreta may lessen morbidity and mortality. This study attempted to examine the placentas of cases in which a hysterectomy confirming accreta was received after delivery to determine whether smooth muscle could be identified on the placenta that was separate from the uterus.
Keywords:  cesarean section, placenta, placenta accreta, postpartum hemorrhage
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