Hello and welcome to the zero to finals podcast.

My name is Tom and in this episode I'm going to be talking to you about placenta acreata.

And you can find written notes on this topic at zero to finals.com slash placenta acreata

or in the antenatal care section of the zero to finals, obstetrics and gynecology book.

So let's get straight into it.

Placenta acreata refers to when the placenta implants deeper through and past the endometrium,

making it difficult to separate the placenta after delivery of the baby.

It's referred to as placenta accretar spectrum, as there's a spectrum of severity in how deep and broad the abnormal

implantation extends. Let's talk about the pathophysiology.

There are three layers to the uterine wall.

The endometrium, which is the inner layer that contains connective tissue,

specifically stroma, epithelial cells and blood vessels.

The myometrium, which is the middle layer that contains

smooth muscle, and the perimetrium, which is the outer layer made of cirrus membrane

similar to the peritoneum, also known as serosa.

Usually the placenta attaches to the endometrium.

This allows the placenta to separate cleanly during the third stage of labour after delivery of the baby. With placenta accreta, the placenta embeds past the endometrium into the myometrium and beyond.

This may happen due to a defect in the endometrium.

Imperfections may occur due to previous uterine surgery, such as a caesarian section or a curatage

procedure.

The deep implantation makes it very difficult for the placenta to separate during delivery,

leading to extensive bleeding or postpartum hemorrhage.

...