EXPLANATION FOR QUESTION 13

 QUESTION 13

Placenta accreta occurs when uterine villi attach directly to the myometrium instead of the decidua. Risk factors for placenta

accreta include a prior cesarean delivery, a history of dilation and curettage, and maternal age >35. Placenta accreta is typically

diagnosed by antenatal ultrasound findings that include irregularity or absence of the placental-myometrial interface and

intraplacental villous lakes. Antenatally diagnosed placenta accreta is delivered by planned cesarean hysterectomy.

Undiagnosed placenta accreta presents as difficulty with placental delivery The .placenta does not detach from the uterus, and this

often results in cord avulsion and necessitates a manual extraction, which is then complicated by placental adherence and severe

hemorrhage (as seen in this patient)

(Choice A) Placental abruption, a common cause of antepartum bleeding , is the premature detachment of the placenta from the

uterus. It presents with vaginal bleeding, abdominal pain, a tense and distended uterus, and fetal heart rate abnormalities. In

contrast, this patient's placenta was difficult to separate from the uterus.

(Choice C) Placenta previa occurs when the placenta implants over the internal cervical os. Contractions and cervical dilation

typically cause antepartum hemorrhage in patients with placenta previa

(Choice D) Uterine atony occurs when the uterus fails to contract after placental delivery This diagnosis is less likely as the patient's

uterus is firm (well-contracted)

(Choice E) Uterine inversion refers to inversion and prolapse of the uterine fundus, which can result from forceful traction on the

umbilical cord and an abnormally adherent placenta. Patients present with severe abdominal pain, postpartum hemorrhage, and a

smooth mass protruding from the cervix or vagina

(Choice F) Vasa previa occurs when fetal vessels traverse the amniotic membranes over the internal cervical os. It presents with

painless antepartum bleeding and fetal heart rate abnormalities just after the rupture of membranes. However, this patient's bleeding

occurred after placental delivery

Educational objective:

Placenta accreta, which occurs when uterine villi attach directly to the myometrium, presents with placental adherence and

hemorrhage at the time of attempted placental delivery. Risk factors include prior cesarean delivery, history of dilation and curettage,

and advanced maternal age