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Placenta Percreta

Etiology: • Unknown

Pathogenesis: • Absent decidua at implantation site due to scar or abnormal implantation site (cervix) • Permits deep invasion of trophoblast either into very superficial myometrium preventing easy separation at delivery (accreta), deeply into myometrium (increta) or through myometrium into adjacent organs (percreta)

Epidemiology: • Associated with placenta previa • Associated with previous C-sections

General Gross Description: • In simple accreta the maternal surface of the placenta is shaggy and irregular with variable amounts of fragmentation of the cotyledons • In increta or percreta the placenta cannot be removed from the uterus at all and rupture of the uterus is a common complication

General Microscopic Description: • Accreta may show adherent myometrium along the basal plate of the placenta • Increta/percreta show villi growing into or through myometrium

Clinical Correlations: • Associated with uterine rupture, hemorrhage, and failure to deliver placenta

References: •Kurman RJ editor. Blaustein's Pathology of the Female Genital Tract, 4th edition, Springer-Verlag, New York, 1994.,pp. 984-5.