Abnormal placentation in the repeat cesarean section

Abstract

Introduction. Abnormal placentation is a challenge of diagnostic and treatment for all perinatal health professionals. The most important risk factors for the development of pathological placental invasion have been identified as birth by previous cesarean section, placenta praevia and advanced maternal age. Antenatal diagnosis can reduce morbidity and mortality; it is usually determined by grayscale ultrasound and confirmed by nuclear magnetic resonance, which can better delimit the degree of placental invasion. The management of pathological placental invasion is one complex and multidisciplinary, because abnormal placentation is associated with significant maternal morbidity and mortality. Objective: to present a literature review on the topic of abnormal placentation based on international studies. Methods and materials: research in international databases by applying in the MedLine search systems, Web of Science keywords – abnormal placentation, cesarean section, placenta accreta, placenta previa, hysterectomy. Results. With the identification of risk factors and the possibilities of obstetric ultrasonography, many cases of placenta accreta are diagnosed prenatally. However, not all patients have access to ultrasound, skilled ultrasound or experienced radiologists or obstetricians who can make these prenatal diagnoses. Due to these limitations, cases of abnormal placenta can only be encountered at birth. Therefore, it is important for all obstetricians to be familiar with the epidemiology, risk factors, diagnosis and management of these potentially very morbid and fatal pathologies of abnormal placentation.