O43.213 Placenta accreta, third trimester

Name of the Condition

• Placenta Accreta, Third Trimester

Summary

Placenta accreta in the third trimester 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, and MRI may be used for further clarification in complex cases. Prenatal monitoring is critical to identify the condition before delivery.

Treatment Options

Management often involves a planned cesarean delivery with hysterectomy to control bleeding. In some cases, conservative management may be considered, but this requires close monitoring. Blood transfusions and other supportive measures are common during delivery.

Prognosis and Follow-Up

Prognosis depends on the severity of placental invasion and management. Post-delivery, mothers require monitoring for bleeding, infection, and other complications. Long-term follow-up may include assessment of uterine health and future pregnancy planning.

Complications

• Severe maternal hemorrhage.
• Uterine rupture or damage.
• Need for emergency hysterectomy.
• Infection.
• Preterm delivery.
• Fetal distress or mortality.

Lifestyle & Prevention

While not always preventable, reducing uterine trauma (e.g., minimizing unnecessary cesarean sections) may lower risk. Prenatal care and early detection of risk factors are key to managing the condition.

When to Seek Professional Help

Seek immediate medical attention for vaginal bleeding, severe abdominal pain, or signs of shock (e.g., dizziness, rapid heartbeat) during pregnancy. Regular prenatal visits are essential for monitoring high-risk cases.

Tips for Medical Coders

Document the trimester (third trimester) and confirm placental attachment details. Ensure clinical notes support the diagnosis, including imaging findings or surgical observations. Code O43.213 is specific to third-trimester placenta accreta and requires clear documentation of timing and severity.