Lessons learnt from two women with morbidly adherent placentas and a review of literature.
BACKGROUND
Pathologically adherent placentas occur when there is a defect of the decidua basalis, typically arising from previous caesarean section, resulting in abnormally invasive implantation of the placenta. The depth of placental invasion varies from the superficial (accreta), to transmural and possibly beyond (percreta).


METHODS
We report on 2 cases, one treated "conservatively", the other with a caesarean hysterectomy, both of which led to a safe outcome for both mother and baby.


CONCLUSIONS
Management relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric haemorrhage at delivery.
Thia
Edwin W H
EW
Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore. edwintwh@gmail.com
Tan
Lay-Kok
LK
Devendra
Kanagalingam
K
Yong
Tze-Tein
TT
Tan
Hak-Koon
HK
Ho
Tew-Hong
TH
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data; D003656:Decidua / Q000002:abnormalities; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015994:Incidence; D008279:Magnetic Resonance Imaging; D010920:Placenta / Q000002:abnormalities / Q000000981:diagnostic imaging; D010921:Placenta Accreta / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011247:Pregnancy; D013785:Thailand / Q000453:epidemiology; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology*