🎧 FREE MSRA PODCAST – Placenta Accreta: When the Placenta Won’t Let Go

A silent threat with life-changing consequences—placenta accreta is one of the most important (and rising) emergencies in modern obstetrics. We break down the core facts you need for the MSRA, using UK NICE guidelines and high-yield revision insights.

📝 Key Learning Points

📌 Definition & Types
• Placenta accreta = placenta attaches abnormally deep into the uterine wall
• Accreta: villi attached to the myometrium
• Increta: villi invade into the muscle
• Percreta: villi invade through the myometrium, may involve bladder/bowel
• Makes separation at delivery very difficult—risk of massive bleeding

📌 Causes & Risk Factors
• Biggest risk: previous Caesarean section (C-section)
 – Risk rises dramatically with each additional C-section (e.g. 1 prev CS ≈ 0.3%, 5 prev CS ≈ 7%)
• Placenta previa, prior uterine surgery, multiparity, advanced maternal age
• More C-sections globally = higher accreta rates

📌 Symptoms
• Often asymptomatic during pregnancy
• Possible sign: painless vaginal bleeding (usually third trimester or at delivery)
• May be suspected if uterus larger than expected, or abnormal fetal heart rate

📌 Diagnosis (UK Pathway)
• Antenatal imaging is vital in high-risk women
 – Ultrasound (first line for placental location and depth of invasion)
 – MRI (if US inconclusive or deep invasion suspected—especially for surgical planning)

📌 Management
• Always multidisciplinary—obstetricians, anaesthetists, haematologists, surgeons
• Planned elective Caesarean hysterectomy (deliver baby, then remove uterus with placenta in situ)
• Blood products ready—high risk of major haemorrhage
• Specialist centre with ICU, experienced pelvic surgeons
• Conservative management (placenta left in situ) possible but risky—consider only if fertility preservation is critical

📌 Complications
• Severe postpartum haemorrhage (PPH)—main immediate threat
• Need for emergency hysterectomy
• Injury to bladder/bowel (especially with percreta)
• Infection (esp. with conservative management)
• Maternal morbidity/mortality

📌 Prognosis
• Depends on depth of invasion, planning, and centre expertise
• Early diagnosis & team-based care improve outcomes
• Still a leading cause of major obstetric haemorrhage

📎 More Placenta Accreta Revision Resources:
📝 Revision Notes: https://www.passthemsra.com/topic/placenta-accreta-revision-notes/
🧠 Flashcards: https://www.passthemsra.com/topic/placenta-accreta-flashcards/
💬 Accordion Q&A: https://www.passthemsra.com/topic/placenta-accreta-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/placenta-accreta-rapid-quiz/
🧪 Quiz Bank: https://www.passthemsra.com/quizzes/placenta-accreta/
🎓 Full Course: https://www.passthemsra.com/courses/obstetrics-and-gynaecology-for-the-msra/

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