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



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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