O43.222 Placenta increta, second trimester

Name of the Condition

• Placenta increta, second trimester

Summary

Placenta increta is a type of morbidly adherent placenta where the placenta abnormally attaches to the uterine wall, invading the muscle layer. In the second trimester, this condition may be identified through prenatal imaging, though symptoms are often subtle. Early detection is critical for planning management and reducing risks to both mother and fetus.

Causes

Placenta increta occurs when the placenta fails to separate properly from the uterine wall due to abnormal placental implantation. This can result from damage to the uterine lining, such as from prior uterine surgery (e.g., cesarean delivery), uterine scarring, or abnormalities in the placental attachment process. The exact cause may not always be identifiable, but disruptions in the normal decidual layer or vascular development are key factors.

Risk Factors

• Prior uterine surgery, including cesarean delivery or myomectomy.
• Uterine scarring or abnormalities (e.g., adenomyosis, fibroids).
• Placenta previa (placenta covering the cervix).
• Advanced maternal age.
• Multiparity (multiple previous pregnancies).
• History of morbidly adherent placenta in prior pregnancies.

Symptoms

• Vaginal bleeding, which may be light or intermittent.
• Mild abdominal discomfort or cramping.
• No specific symptoms may be present in early stages; diagnosis often relies on imaging.

Diagnosis

Diagnosis is typically made using ultrasound or MRI to assess placental attachment and invasion. These imaging studies help differentiate placenta increta from other morbidly adherent placenta types and guide management planning. Prenatal monitoring is essential to track progression and prepare for delivery.

Treatment Options

Management focuses on specialized delivery planning, often involving a multidisciplinary team. Delivery is typically scheduled via cesarean section with hysterectomy to control bleeding. Blood transfusion and other supportive measures may be necessary. Postpartum care includes monitoring for complications like hemorrhage or infection.

Prognosis and Follow-Up

Prognosis depends on the extent of placental invasion and management. Most cases require hysterectomy to control bleeding, but outcomes improve with early detection and coordinated care. Follow-up includes monitoring for anemia, infection, or other complications, and future pregnancy planning should consider risks.

Complications

• Severe maternal hemorrhage during or after delivery.
• Uterine rupture or damage requiring hysterectomy.
• Infection or sepsis.
• Preterm delivery or fetal distress.
• Long-term maternal morbidity, including infertility or chronic pain.

Lifestyle & Prevention

While prevention is limited, avoiding unnecessary uterine procedures and optimizing uterine health may reduce risk. Prenatal care should include screening for placental abnormalities, especially in high-risk patients. Maintaining a healthy pregnancy and addressing uterine conditions early can support better outcomes.

When to Seek Professional Help

Seek immediate care for vaginal bleeding, severe abdominal pain, or signs of shock (e.g., dizziness, rapid heartbeat). Prenatal providers should be consulted for any concerns about placental health, especially in high-risk pregnancies. Early evaluation is critical for managing complications.

Tips for Medical Coders

Document the trimester (second trimester) and confirm the diagnosis via imaging or clinical findings. Ensure the code O43.222 is used only when placenta increta is specifically identified, with clear documentation of the condition and trimester. Include details of prenatal monitoring, imaging results, and management plans to support accurate coding.