PLACENTA ACCRETA, ABOUT A CASE

Yassine Edahri*, Pr. Aziz Baydada, Pr. Amina Lakhdar, Pr. Najia Zraidi, Dr. Intissar Benzina and
Dr. Benmouna Imane

ABSTRACT

Placenta accréta is an adhesion abnormality of the placenta responsible for abnormal myometrial invasion by tissue and trophoblastic tissue. Depending on the degree of myometrium involvement, we can distinguish placenta accreta (<50% myometrium), placenta increta (> 50% myometrium) and placenta percreta (affected beyond the serosa and neighboring organs). The pathophysiological mechanism remains unknown, processes involving increased secretion of placental invading factors by the cytotrophoblast, excessive vascular remodeling or a combination of the two appear to be partly to blame. The main risk factors are dominated by the history of cesarean section and uterine surgery. Endo-uterine procedures such as haemostatic curettage, hysteroscopy as well as a history of endometritis are increasingly correlated with the occurrence of placenta accreta. Conventional 2D ultrasound is the gold standard for screening for placenta accreta. Magnetic reasoning imaging does not have better diagnostic sensitivity than ultrasound, but it remains more effective in determining the degree of myometrial invasion, particularly in cases of posterior placenta and suspicion of a percreta placenta. The definitive diagnosis is pathological. The numerous mainly hemorrhagic complications observed during the placenta accreta, that may affect the vital prognosis of the mother and the fetus, require early detection and strict and regular pregnancy monitoring as well as multidisciplinary care. The principle of treatment is based either on radical treatment by hysterectomy, conservative treatment can be discussed in certain cases, in particular to preserve fertility. embolization of the uterine arteries is proposed especially in case of conservative treatment. We report the case of a placenta acrreta in a parturient admitted to the emergency department of the souissi rabat maternity unit. The aim of our study is to shed light on the main risk factors and pathophysiological mechanisms that can induce a placenta accreta as well as the different diagnostic and therapeutic modalities.

Keywords: placenta accreta, scarred uterus, endo uterine gestures, hysterectomy.