What is placenta accreta?

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

Placenta accreta occurs when placental villi attach directly to the myometrium (the muscular layer of the uterus) instead of the endometrium.
This abnormal adherence is caused by a defect in the decidua basalis, the specialized layer of the endometrium that normally prevents deep placental invasion.
Because the placenta is abnormally anchored, it fails to separate from the uterine wall after delivery, which can lead to severe, life-threatening hemorrhage.

Option A: Attachment to the endometrium is the correct and normal site for placental implantation.
Option B: This describes placenta previa, which is an abnormality of the placenta's location (low-lying), not its depth of attachment.
Option C: Attachment to the upper uterine segment is a normal and common location for the placenta. It does not describe a pathological condition.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Placental attachment abnormalities as background academic context rather than a clinical decision trigger.
Placenta accreta spectrum (PAS) is a life-threatening obstetric emergency due to the high risk of massive postpartum hemorrhage when placental separation is attempted.
Management often requires a planned preterm cesarean delivery followed by a hysterectomy (removal of the uterus) to control the bleeding, as the placenta cannot be safely removed.
Nursing care involves intensive monitoring for bleeding, ensuring large-bore IV access, and preparing for massive transfusion protocols.

How to Approach the Question

This is a direct recall question asking for the definition of a specific medical term.
Identify the key term in the question: "placenta accreta."
Recall the anatomy of the uterine wall, which consists of three main layers: the endometrium (inner lining), myometrium (middle muscular layer), and perimetrium/serosa (outer layer).
Remember that in a normal pregnancy, the placenta attaches to the endometrium.
The term "accreta" means to adhere or grow onto. In this context, it signifies an abnormally deep attachment.
Evaluate each option: Option A is normal. Options B and C describe location (previa vs. normal), not depth. Option D correctly describes the placenta adhering to the myometrium (muscle layer), which is the definition of placenta accreta.

Concept Tested & Keywords

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E6 Obstetrics Williams pp. 73-89, 71-94

Practise the full DSSSB - 28 August 2019 (Shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.