O43.223 Placenta increta, third trimester

Name of the Condition

• Placenta Increta, Third Trimester

Summary

Placenta increta, third trimester, is a type of morbidly adherent placenta where the placenta abnormally attaches to the uterine wall and invades the myometrium (uterine muscle layer) during the third trimester of pregnancy. 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 myometrium. Clinical evaluation may include assessing for risk factors and symptoms, with confirmation often requiring imaging to differentiate from other morbidly adherent placenta types.

Treatment Options

Management involves a multidisciplinary approach, including planned delivery via cesarean section with possible hysterectomy to control bleeding. Blood transfusions and uterine artery embolization may be used to manage hemorrhage. Post-delivery care focuses on monitoring for complications and supporting maternal recovery.

Prognosis and Follow-Up

Prognosis depends on the severity of placental invasion and management of complications. Close follow-up is essential to monitor for delayed hemorrhage, infection, or other postpartum issues. Future pregnancies may require additional planning due to increased risk of recurrence.

Complications

• Severe postpartum hemorrhage.
• Uterine rupture or damage.
• Need for hysterectomy.
• Infection.
• Blood transfusion reactions.
• Maternal or fetal mortality in severe cases.

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 in high-risk patients.

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 the third trimester. Early evaluation is critical for managing complications.

Tips for Medical Coders

Document the trimester (third trimester) and confirm the diagnosis of placenta increta with clinical or imaging findings. Ensure documentation supports the specific type of morbidly adherent placenta to justify the code. Note any associated complications or interventions for accurate coding.