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Risks Associated with Abnormally Invasive Placenta

Discuss about the First Trimester Detection of Abnormally Invasive Placenta.

The invasive placenta is a condition which makes the placenta attaches itself too strongly or deeply in the walls of the uterus. This situation may make the placenta not to get separate and deliver as usual during childbirth; it may result in extra bleeding if efforts to remove the placenta are made. The invasive placenta is categorized in placenta accrete in which the placenta attaches itself too firmly into the muscular layer of the uterine wall, but it does not invade the uterine wall. Placenta increta which are a condition in which the placenta invades the myometrium, and lastly we have the placenta percreta in which the placenta invades through the thickness of the uterine wall and can as well attach itself strongly to the adjacent organ of the abdomen mostly the blander. However, most scientific researchers use the placenta accreta to refer to all the categories of the invasive placentation. According to the electronic research of EMBASE, MEDLINE and CINAHL databases which was performed between 2000 and 2016 reports that are on the first-trimester diagnosis of the abnormally invasive placenta is successively confirmed in the trimester of pregnancy in either operative delivery or pathological examination. The data was analyzed using random-effects meta-analysis, a meta-analysis of proportion and the hierarchical summary receiver-operating characteristics. A recent study conducted confirmed that ultrasound signs of AIP can be present during the first trimester of pregnancy and can also be there before the 11 weeks gestation period. Low implantation of placenta close or within the scar is mostly seen early ultrasound signs. This has made ultrasound detection key in identifying AIP cases in mothers during the first trimester.

 In this paper, I will start by conducting an in-depth literature review the literature review of other researchers who have carried research on invasive placenta cases risks in women during their first trimester. After the review, I will reflect my experience during my clinical placement period where I was able to work closely with AIP patients.

Thompson, O., Otigbah, C., Nnochiri, A., Sumithran, E. and Spencer, K., 2015. First trimester maternal serum biochemical markers of aneuploidy in pregnancies with abnormally invasive placentation. BJOG: An International Journal of Obstetrics & Gynaecology, 122(10), pp.1370-1376. https://obgyn.onlinelibrary.wiley.com/toc/14710528/122/10

In this article, Thompson and the other publishers asserts that placenta accreta which is believed to be related to abnormalities in the lining of the uterus which is typically caused by scarring after C-section or other uterine surgery is performed during pregnancy. This operation makes the placenta grow too strong and close to the uterine wall (Thompson et al. 2015, p.1370). Normally the placenta attaches itself to the outer layer of the uterine wall. The placenta is supposed to be too strong to anchor to the uterine wall until the end of the pregnancy, and it has to detach itself from the will immediately after the baby is delivered. However, studies report that invasive placenta can occur without any history of uterine surgery. The uterus wall is very significant in attaining this balance just because it has to control the depth of invasion of the placenta and its capability to release when the baby is born. In case the uterus is damaged it becomes abnormal and invasive placenta may occur. It is commonly observed in the area of the scar on the uterine wall from the previously done uterine surgery (Thompson et al. 2015, p.1370). If a woman is at high risk of invasive placenta an ultrasound and MRI test can be performed to help diagnose invasive placenta. Ladies are technically advised to seek medical attention in cases where they sense they may be victims of invasive placenta so that the necessary actions can be taken before the situations worsen (Thompson et al. 2015, p.1370). They are also advised to keep away from situations and conditions that may expose their uterus at risk like performing heavy tasks which can damage the uterus during pregnancy which causes invasive placenta this is whereby the placenta attaches itself too strongly to the uterus and may not detach from the uterine wall during delivery.

Diagnosis of Abnormally Invasive Placenta

Belfort, M.A., Shamsirsaz, A.A. and Fox, K.A., 2017, November. The diagnosis and management of morbidly adherent placenta. In Seminars in perinatology. WB Saunders.

Belfort, Shamsirsaz & Fox (2017) published a document on the risks associated with invasive placentation. History of damage to the uterus increases the chances of the invasive placenta. Some of this risk factors include a previous cesarean section which is categorized as the biggest risk factor for the invasive placenta. The risk of future invasive placenta increases progressively with the number of which is a lady is done the operation or cesarean delivery. This is because cesarean deliveries leave the women with scars on the internal surface of the uterus and with subsequent pregnancies; this scar becomes a site for invasive placentation (Belfort, Shamsirsaz & Fox, 2017, np). Women who have had more than one caesarean delivery are at very high risk of invasive placentation in which the placenta is always lying low across the previous uterus scar. In cases where the ultrasound test locates a placenta to be in the normal position or on the back wall then the risk of the invasive placenta is termed to be low. A special type of caesarean operation which is known as the classical caesarean section is sometimes done in complicated pregnancies during childbirth. However, classical caesarean section exposes women to very high risks of invasive placentation in subsequent pregnancies (Belfort, Shamsirsaz & Fox, 2017, np). This is because it is a vertical incision up in the middle uterus and most cases, it is reported that the placenta implants or attaches itself to the scar causing invasive placentation. Another risk factor for invasive placentation is previous gynecological uterine surgery such as myomectomy which is the removal of a fibroid (Belfort, Shamsirsaz & Fox, 2017, np). This is because it involves dilation of the cervix and the curettage or removal of tissues from the uterus. Dilations and curettage of tissues from the uterus are performed to a lady in a situation where they experience menstrual problems or after pregnancy when they experience excessive vaginal bleeding. This increases the risk of invasive placentation due to scarring of the uterus wall (Belfort, Shamsirsaz & Fox, 2017, np). However, dilation and curettage of tissues from the uterus are a significant operation s it restores the health of a patient and majority of women who have an uncomplicated operation about the same do not have invasive placentation in their future pregnancies.

Management of Abnormally Invasive Placenta

Almeida, W. and Dickinson, J.E., 2017. EP15. 06: A case of abnormally invasive placentation in a nulliparous woman following uterine artery embolisation for uterine fibroids. Ultrasound in Obstetrics & Gynecology, 50(S1), pp.328-329. https://www.tjog-online.com/article/S1028-4559%2817%2930086-4/pdf?code=tjog-site

Almeida and Dickinson (2017) focus on the management of invasive placentaion. In cases where the diagnosis of the invasive placenta is made or suspected the placenta, clinic suggests the following plans. A woman who is diagnosed with invasive placentation is advised to go through antenatal evaluation which is carried out by a team of experienced experts in diagnosing invasive placenta using the ultrasound and MRI tests. A team of experienced experts with operational challenges is assigned for caring and managing patients who are diagnosed with invasive placenta after the ultrasound and MRI tests (Almeida & Dickinson, 2017, p.328). Each woman suffering from invasive placenta together with a family a care plan is developed to benefit them. This care plans developed is to incorporate her previous medical and obstetrical history. However, the care plan includes a planned caesarean delivery in a particular unit and also a planned hysterectomy in many situations (Almeida & Dickinson, 2017, p.328). Vascular and interventional radiology is a significant item of care to those women who are suspected to be suffering from the invasive placenta. Vascular and interventional radiology is termed as a significant integral part of assessment and management of ladies who are suspected to be suffering from the invasive placenta (Almeida & Dickinson, 2017, p.328). A successful case of the first successful plan of the conservative management of invasive placentation indicates that caesarean delivery deliberately leaves the placenta in the uterus and it takes several months to dissolve completely as it dissolves slowly. Heavy vaginal bleeding that can occur after pregnancy due to invasive placenta can be handled by a group of experienced experts by dilation and removal of the uterus tissues which may be worsening the condition (Almeida & Dickinson, 2017, p.328).  Bleeding which can cause a life-threatening situation and it prevents blood from clotting as well kidney failure can be handled by carrying out blood transfusion to the patients in cases where they have lost a lot of the blood. In situations where invasive placentation causes premature birth in which the placenta accreta causes a lot of bleeding during pregnancy, and the patient has to deliver their babies early, the babies can be kept under incubation care.

Muralimanoharan, S., Maloyan, A. and Myatt, L., 2016. Mitochondrial function and glucose metabolism in the placenta with gestational diabetes mellitus: role of miR-143. Clinical Science, 130(11), pp.931-941.

In their article, (Muralimanoharan, Maloyan & Myatt, 2016, p.931) focus of the role placental functioning testing in pregnant women. The invasive placenta can be strongly be detected by ultrasound scan in which the texture of the placenta and its border with muscles of the uterus are seen to be abnormal. Another test which can be performed to detect invasive placenta is MRI scan. It is said to be the best test which confirms the results of the ultrasound. This is done to those patients who have an abnormal placental appearance suggesting an invasive placenta. This two test is carried out to detect if the placenta is performing its roles appropriately (Muralimanoharan, Maloyan & Myatt, 2016, p.931). This is because the placenta performs the critical function of determining the health of the baby and the mother. The health of the placenta can be assessed by testing the blood or urine of the mother. When the physician has this information about the health of the placenta, they can enhance the outcomes of the pregnancy, and they give the best guide to the mother to ensure they don't end up going through caesarean delivery which makes them be at very high risk of invasive placentation in their future pregnancies (Muralimanoharan, Maloyan & Myatt, 2016, p.931).  Professionals are also in better position to intervene and prevent circumstances such as stillbirth or babies being born too small. The following are the components of the placental function test. Maternal biochemistry in which the particular proteins in the maternal blood are tested and the results are reported as Multiple of Medium (MoM). Placental ultrasound is another component of placental function test in which the placental size, shape, and texture are tested (Muralimanoharan, Maloyan & Myatt, 2016, p.931). The last component is the uterine artery Doppler which tests how the blood flows from the mother to the placenta through the left and the right.

During my clinical placement at Campbell town medical clinic, I had the opportunity to observe first trimester ultrasound amidst my experienced supervisor. Through observation and daily involvements, I learnt that this area was quite interesting as it had special materials and measures which were using ultrasound. I embarked on a research on this topic and began reviewing records on IAP patients who had visited the clinic in the last 1 year. Through the information collected about the health condition, I was able to master the key steps undertaken in detecting the health condition. Also, familiarized myself with the lurking and danger and complications that may arise in cases of women facing the risks of getting invasive placenta. Through the review, and attending actual sessions during my clinical placement with this type of condition, I was be able to identify the procedure of detecting invasive placentation cases in pregnant women during their early states and tell if there were abnormalities.

I reviewed four journal articles after which I noted that; identifying the causes is essential as it helps to administer the right treatment to the patient (Huang et al. 2015, p.709). The cause of the health condition is also useful as it helps physicians take the first action in stopping the bleeding problems that mostly come along with the invasive placenta women. Conducting a literature review is crucial as it helped me in understanding the causes of the invasive placenta in high-risk women at their early pregnancies through the studies conducted by other researchers on the same. 

Carrying out literature on the risk factors of the invasive placenta was of help as it helped me quantify the extent of the condition in patients during my actual study. With a noble on the encompassing risks, I will be able to achieve my hypothesis fast and with ease. The risk factors are essential as they help physicians come up with treatment measures that are fit for different patients (Usta et al. 2005, p.1045). Conducting a literature review of the risk factors equipped me with the knowledge and skill of grouping the extent of risks in patients.

Carrying out a literature review on the management of the complication was essential as it helped me understand the necessary process that ought to be observed to manage the condition. The management literature is useful as it will help me keep the condition under check (Wah et al. 2017, p.14).

Conclusion

In conclusion, the invasive placenta has been a life-threatening health condition to many women in the present world. Women who suspect to be suffering from this condition are advised to seek medical attention early in advance before it worsens so that the necessary preventive measures can be taken by detecting the pregnancy issues by use of ultrasound and MIR tests. Cesarean deliveries and dilation and curettage and removal of tissues from the uterus which are known as the main contributors towards invasive placentation among women as they leave scars in the uterus should be highly discouraged. This is because the scars which are left makes the placenta attach itself too closely and strongly in the uterine wall and may not detach or separate from the uterus during the delivery of the baby in the future pregnancies. Alternative deliveries are highly encouraged like the natural method which cannot lead to such complications of invasive placentation. This can be achieved by giving the correct advice and encouraging pregnant mothers to do some physical exercises in their pregnancy s they are highly significant for those individuals who do not want to go through caesarean delivery. Pregnant mothers should also seek medical attention to test if their placenta which performs some critical operations is working properly. This is tested through blood and urine screening. Women diagnosed with invasive placenta should be put under care and management of highly experienced physicians. 

References

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.18840

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.12413

Almeida, W. and Dickinson, J.E., 2017. EP15. 06: A case of abnormally invasive placentation ina nulliparous woman following uterine artery embolization for uterine fibroids. Ultrasound inObstetrics & Gynecology, 50(S1), pp.328-329.

Belfort, M.A., Shamsirsaz, A.A. and Fox, K.A., 2017, November. The diagnosis and management of morbidly adherent placenta. In Seminars in perinatology. WB Saunders.

Bhide, A., Sebire, N., Abuhamad, A., Acharya, G. and Silver, R., 2017. Morbidly adherent placenta: the need for standardization. Ultrasound in Obstetrics & Gynecology, 49(5), pp.559-563.

Huang, T., Dennis, A., Meschino, W.S., Rashid, S., Mak?Tam, E. and Cuckle, H., 2015. First trimester screening for Down syndrome using nuchal translucency, maternal serum pregnancy?associated plasma protein A, free?β human chorionic gonadotrophin, placental growth factor, and α?fetoprotein. Prenatal diagnosis, 35(7), pp.709-716. https://www.researchgate.net/publication/258523336_Elevated_first_trimester_PAPP-A_is_associated_with_increased_risk_of_placenta_accreta

Morlando, M., Sarno, L., Napolitano, R., Capone, A., Tessitore, G., Maruotti, G.M. and Martinelli, P., 2013. Placenta accreta: incidence and risk factors in an area with a particularlyhigh rate of cesarean section. Acta obstetrician et gynecological Scandinavica, 92(4), pp.457-460. 

Muralimanoharan, S., Maloyan, A. and Myatt, L., 2016. Mitochondrial function and glucose metabolism in the placenta with gestational diabetes mellitus: role of miR-143. ClinicalScience, 130(11), pp.931-941.

Pucci, L., Massacesi, M. and Liuzzi, G., 2018. Clinical management of women with listeriosisrisk during pregnancy: a review of national guidelines. Expert review of anti-infective therapy,(just-accepted).

Thompson, O., Otigbah, C., Nnochiri, A., Sumithran, E. and Spencer, K., 2015. First trimestermaternal serum biochemical markers of aneuploidy in pregnancies with abnormally invasive’placentation. BJOG: An International Journal of Obstetrics & Gynaecology, 122(10), pp.1370-1376. https://obgyn.onlinelibrary.wiley.com/toc/14710528/122/10

Usta, I.M., Hobeika, E.M., Musa, A.A.A., Gabriel, G.E. and Nassar, A.H., 2005. Placenta previa

accreta: risk factors and complications. American Journal of Obstetrics & Gynecology, 193(3),pp.1045-1049.

Wah, Y.M., Leung, T.Y., Cheng, Y.K.Y. and Sahota, D.S., 2017. Procedure-related fetal lossfollowing chorionic villus sampling after first-trimester aneuploidy screening. Fetal diagnosisand therapy, 41(3), pp.184-190.

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