O43.22 Placenta increta

Name of the Condition

• Placenta Increta

Summary

Placenta increta is a type of morbidly adherent placenta where the placenta abnormally attaches to the uterine wall and invades the myometrium (uterine muscle layer). This condition can lead to significant complications during delivery, including severe hemorrhage and uterine damage, requiring specialized management to minimize risks to the mother and fetus.

Causes

Placenta increta occurs due to abnormal placental implantation, where the placenta fails to separate properly from the uterine wall after delivery. This is often associated with scarring or damage to the uterine tissue, such as from prior uterine surgery (e.g., cesarean sections) or other uterine abnormalities that disrupt the normal separation process.

Risk Factors

• Prior uterine surgery, including multiple cesarean deliveries.
• Advanced maternal age.
• Placenta previa (placenta covering the cervix).
• Previous history of morbidly adherent placenta.
• Uterine conditions like fibroids or endometrial scarring.
• Multiparity (having had multiple pregnancies).

Symptoms

• Vaginal bleeding during the third trimester, which may be painless or accompanied by cramping.
• Abnormal placental location noted on prenatal imaging.
• Uterine tenderness or pain during pregnancy.
• Signs of anemia or shock if bleeding occurs.

Diagnosis

Diagnosis is typically made through prenatal imaging, such as ultrasound or MRI, which can identify abnormal placental attachment and invasion of the uterine muscle. Clinical suspicion may arise from risk factors or symptoms, and imaging helps confirm the extent of placental invasion.

Treatment Options

Management involves a multidisciplinary approach, often including planned delivery via cesarean section with hysterectomy to control bleeding. In some cases, conservative management (e.g., leaving the placenta in situ) may be considered, but this carries risks of infection or prolonged bleeding. Blood transfusion and intensive care support are frequently required.

Prognosis and Follow-Up

Prognosis depends on the severity of placental invasion and management. Severe cases can lead to life-threatening hemorrhage, but timely intervention improves outcomes. Post-delivery follow-up includes monitoring for complications like infection or retained placental tissue, with ongoing care to address maternal recovery.

Complications

• Severe postpartum hemorrhage.
• Uterine rupture or damage.
• Need for emergency hysterectomy.
• Infection or sepsis.
• Maternal mortality (in severe cases).
• Preterm delivery or fetal distress.

Lifestyle & Prevention

While prevention is limited, reducing risk factors (e.g., minimizing unnecessary uterine surgeries) may help. Prenatal care and early detection through imaging are critical for planning delivery and managing complications.

When to Seek Professional Help

Seek immediate medical attention for vaginal bleeding during pregnancy, severe abdominal pain, or signs of shock (e.g., dizziness, rapid heartbeat). Prenatal care providers should be consulted for regular monitoring if risk factors are present.

Tips for Medical Coders

Document the clinical findings supporting the diagnosis, including imaging results and surgical notes. Ensure the code O43.22 is used when placenta increta is confirmed, with clear differentiation from other morbidly adherent placenta types. Include details on management and complications to support accurate coding.