The placenta cretas involve ingrowths of placental tissue into the uterine wall, causing the placenta to be abnormally adherent and difficult to remove.
Complications of placenta creta:
(1) severe maternal hemorrhage
(2) placenta rupture
(3) emergency hysterectomy
(4) endometritis (if remnants of the placenta are left behind)
(5) fetal morbidity and mortality
Common gross findings:
(1) difficult or impossible placenta extraction
(2) highly fragmented basal plate with torn cotyledons
Histologic findings:
(1) absence of the decidual layer
(2) trophoblasts extending directly into the myometrium or into uterine blood vessels
(3) abnormal maternal vascular remodeling
Term
Finding
placenta accreta, partial
extension of trophoblasts into the superficial myometrium over a limited area of the basal plate
placenta accreta, totalis
extension of trophoblasts into the superficial myometrium over the entire basal plate
placenta increta
trophoblasts invade deeply into the myometrium but not through
placenta percreta
trophoblasts invade through the placenta, penetrating the serosa
Placenta increta and percreta need to be separated from malignant trophoblastic tumors.
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