PLACENTA-ACCRETA - MILD CASES DIAGNOSED BY PLACENTAL EXAMINATION

We describe 36 placentas in which microscopic foci of myometrial tissu e were adherent to the basal plate with deficient intervening decidua, consistent with a mild or focal form of placenta accreta. In only fou r cases was a diagnosis of placenta accreta considered clinically, and none of the cases resulted in hysterectomy. Twenty-one of the mothers underwent cesarean section for the current pregnancy, with 10 of the mothers having a history of previous cesarean section. The placenta fa iled to separate spontaneously in eight of the 15 vaginal deliveries n ecessitating manual removal of the placenta. Additional maternal facto rs included multiparity in 33, placenta previa in two, leiomyomas in t wo, and previous spontaneous abortion or voluntary interruption of pre gnancy in 23. Four cases were complicated by retained placental fragme nts and three by postpartum hemorrhage. We conclude that these milder cases of placenta accreta are frequently associated with previous uter ine operations and multiparity, and although not uncommon, are frequen tly not clinically suspected. Placental examination is useful in makin g the diagnosis of placenta accreta in cases not requiring hysterectom y, particularly if the basal plate is well sampled.