A condition in which placenta is directly attached to the myometrium:
A. placenta battledore B. Placenta velamentous C. Placenta praevia D. Placenta accreta
Correct Answer: D. Placenta accreta
Explanation
The question is asking about a placental abnormality in which the placenta attaches abnormally deep into the uterine wall. Normally, the placenta attaches to the endometrium (the inner lining of the uterus) but does not invade the myometrium (the muscular layer of the uterus).
When the placenta is directly attached to the myometrium, this is called Placenta Accreta.
Here’s a clear breakdown:
- Normal attachment: Placenta attaches to the endometrium.
- Placenta Accreta: Placental villi attach directly to the myometrium, without invading it deeply.
- Placenta Increta: Placental villi invade into the myometrium.
- Placenta Percreta: Placental villi penetrate through the myometrium and may reach the serosa or adjacent organs like the bladder.
Key point:
- In Placenta Accreta, the placenta is abnormally adherent but does not penetrate deeply, which can cause problems during delivery because the placenta may not separate properly, leading to severe bleeding.
So, the answer to your question is: Placenta Accreta.
Other Options Details
Here’s a detailed explanation of each of the options you listed:
A. Placenta Battledore
- Definition: A type of umbilical cord insertion where the cord attaches at the very edge of the placenta rather than near the center.
- Appearance: Resembles a “paddle” or “tennis racket,” hence the term battledore.
- Clinical Significance: Usually benign, but sometimes associated with mild complications like reduced placental efficiency or bleeding if other risk factors exist.
B. Placenta Velamentous
- Definition: The umbilical cord inserts into the fetal membranes (chorioamniotic membranes) instead of directly into the placenta. The blood vessels then travel unprotected over the membranes before reaching the placenta.
- Risks:
- Vulnerable blood vessels can rupture (vasa previa), leading to fetal hemorrhage.
- Associated with growth restriction or preterm birth.
C. Placenta Praevia
- Definition: The placenta partially or completely covers the cervical opening (os).
- Types:
- Complete: Fully covers the cervical os.
- Partial: Partially covers the os.
- Marginal: Reaches the edge of the os.
- Clinical Significance:
- Can cause painless vaginal bleeding in the second or third trimester.
- Delivery usually requires cesarean section to prevent hemorrhage.
D. Placenta Accreta
- Definition: The placenta abnormally adheres to the myometrium (uterine muscle) rather than detaching normally after delivery.
- Subtypes:
- Accreta: Villi attach to the myometrium.
- Increta: Villi invade the myometrium.
- Percreta: Villi penetrate through the myometrium, possibly reaching other organs.
- Clinical Significance:
- Can cause severe postpartum hemorrhage.
- Often requires surgical intervention, sometimes hysterectomy.
I hope that you liked this article.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group