O43.21 Placenta accreta

Name of the Condition

• Placenta Accreta

Summary

Placenta accreta is a condition where the placenta abnormally attaches too deeply into the uterine wall, often penetrating the muscle layer. This can lead to difficulties during delivery, as the placenta may not separate properly from the uterus. The condition requires careful management to minimize complications for both the mother and fetus.

Causes

Placenta accreta occurs when the placenta invades the uterine wall, often due to abnormalities in the decidua (the uterine lining). This can result from scarring or damage to the uterine tissue, such as from previous cesarean sections, uterine surgery, or other uterine procedures. In some cases, the exact cause may not be identifiable, but uterine trauma is a common contributing factor.

Risk Factors

• Previous uterine surgery, including cesarean deliveries.
• Placenta previa (placenta covering the cervix).
• Advanced maternal age.
• Multiparity (having had multiple pregnancies).
• Uterine abnormalities or scarring.
• Prior uterine procedures, such as dilation and curettage (D&C).

Symptoms

• Vaginal bleeding during the third trimester.
• Abdominal pain or tenderness.
• Difficulty separating the placenta after delivery.
• Excessive bleeding during or after childbirth.
• Uterine tenderness or firmness.

Diagnosis

Diagnosis is typically made using ultrasound imaging to assess placental attachment and depth of invasion. Doppler studies may evaluate blood flow to the placenta, and MRI may be used for further clarification in complex cases. Clinical evaluation during delivery, such as difficulty removing the placenta, may also confirm the diagnosis.

Treatment Options

• Planned cesarean delivery with hysterectomy (removal of the uterus) to manage severe cases.
• Conservative management, including leaving the placenta in place and using medications to promote regression.
• Blood transfusions and other supportive care to manage bleeding.
• Close monitoring during and after delivery to address complications.

Prognosis and Follow-Up

Prognosis depends on the severity of the condition and timely intervention. With proper management, outcomes for the mother can be favorable, though hysterectomy may be necessary in severe cases. Follow-up care includes monitoring for infection, bleeding, and long-term reproductive health. Future pregnancies may require specialized planning.

Complications

• Severe maternal hemorrhage during or after delivery.
• Need for hysterectomy.
• Infection or sepsis.
• Damage to surrounding organs, such as the bladder or intestines.
• Preterm delivery or fetal distress.

Lifestyle & Prevention

• Avoid unnecessary uterine procedures to reduce scarring.
• Manage risk factors, such as placenta previa, with prenatal care.
• Discuss prior surgeries with healthcare providers to assess risk.
• Attend regular prenatal check-ups for early detection.

When to Seek Professional Help

Seek immediate medical attention if experiencing vaginal bleeding, severe abdominal pain, or signs of hemorrhage during pregnancy. Contact a healthcare provider if there is difficulty separating the placenta after delivery or if excessive bleeding occurs.

Tips for Medical Coders

Document the diagnosis of placenta accreta with specificity, including details of placental attachment and any complications. Note the presence of risk factors, such as prior uterine surgery or placenta previa, to support coding accuracy. Ensure documentation aligns with clinical findings and management decisions for proper code assignment.