O43.232 Placenta percreta, second trimester

Name of the Condition

• Placenta Percreta, Second Trimester

Summary

Placenta percreta is a type of morbidly adherent placenta where the placenta abnormally attaches to the uterine wall and penetrates through the myometrium (uterine muscle layer), potentially reaching the uterine serosa or adjacent organs. This condition can lead to severe complications during pregnancy and delivery, including life-threatening hemorrhage and uterine or organ damage. Management requires specialized care to minimize risks to both the mother and fetus.

Causes

Placenta percreta occurs due to abnormal placental implantation, where the placenta invades the uterine wall deeply. 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. The exact cause may not always be identifiable, but uterine trauma is a common contributing factor.

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 second 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. Clinical evaluation may include assessing symptoms like bleeding or pain, and additional tests may be performed to evaluate maternal and fetal well-being.

Treatment Options

Treatment depends on the severity and gestational age. Management may involve close monitoring, planned delivery (often via cesarean section) with a multidisciplinary team, and potential hysterectomy to control bleeding. Blood transfusions or other interventions may be necessary to manage hemorrhage.

Prognosis and Follow-Up

Prognosis varies based on the extent of placental invasion and complications. Close follow-up is essential to monitor for delayed bleeding, infection, or other issues. Long-term care may include reproductive counseling and management of any residual uterine or organ damage.

Complications

• Severe maternal hemorrhage.
• Uterine rupture or damage.
• Injury to adjacent organs (e.g., bladder, bowel).
• Preterm delivery.
• Maternal or fetal mortality in severe cases.

Lifestyle & Prevention

While prevention is not always possible, reducing risk factors (e.g., minimizing unnecessary uterine surgeries) may help. Prenatal care and early detection through imaging can improve outcomes.

When to Seek Professional Help

Seek immediate medical attention for vaginal bleeding, severe abdominal pain, dizziness, or signs of shock during pregnancy. Regular prenatal visits are critical for monitoring and early intervention.

Tips for Medical Coders

Document the specific trimester (second trimester) and confirm the diagnosis of placenta percreta. Ensure clinical documentation supports the severity and any associated complications to justify coding. Follow guidelines for morbidly adherent placenta coding, noting the distinction between accreta, increta, and percreta.