Which of the following conditions involves the placenta penetrating through the uterine

wall and extending to other organs?

Appeared in: BTSC 3 August 2025

Explanation

Placenta percreta is defined by placental villi penetrating through the entire thickness of the uterine wall, including the myometrium (muscle) and the serosa (outer layer).
The defining characteristic that matches the question is the extension of the placental tissue to invade adjacent organs, such as the urinary bladder or rectum.
This condition is the most severe form of the Placenta Accreta Spectrum (PAS) and carries the highest risk of life-threatening maternal hemorrhage and morbidity.

Option A: Placenta increta involves the invasion of placental villi into the myometrium (uterine muscle), but not through it. It does not extend to other organs.
Option C: Placenta accreta is the least severe form, where the villi attach abnormally to the surface of the myometrium but do not invade the muscle itself.
Option D: Battledore placenta is a morphological abnormality concerning the insertion of the umbilical cord at the margin (edge) of the placenta, not the depth of placental implantation.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification of abnormal placental implantation (Placenta Accreta Spectrum) as background academic context rather than a clinical decision trigger.
Placenta Accreta Spectrum (PAS) is a major cause of severe maternal hemorrhage, often requiring massive blood transfusions and admission to the Intensive Care Unit (ICU).
Antenatal diagnosis with ultrasound and/or MRI is crucial for planning delivery at a tertiary care center with a multidisciplinary team (including obstetric surgeons, anesthesiologists, and blood bank support).
The standard management for placenta percreta is a planned preterm cesarean hysterectomy (removal of the uterus with the placenta left in place) to prevent catastrophic bleeding that would occur if placental separation were attempted.

How to Approach the Question

First, identify the key terms in the question: "penetrating through the uterine wall" and "extending to other organs."
Recall the definitions for the different types of abnormal placentation in the Placenta Accreta Spectrum.
Differentiate between 'accreta' (adherence to muscle), 'increta' (invasion into muscle), and 'percreta' (penetration through the muscle and beyond).
Recognize that 'percreta' is the only condition that involves penetration through the entire uterine wall and potential invasion of other organs.
Eliminate 'Battledore placenta' as it relates to the umbilical cord insertion site, not the depth of placental invasion.
Select the option that matches the most severe form of invasion described in the question.

Concept Tested & Keywords

Concept Tested: Classification of abnormal placental implantation (Placenta Accreta Spectrum).
Stem keywords: placenta, penetrating, uterine wall, other organs
Lead-in keywords: Which of the following

Qsw45zwHmszp1BdtznjX-h

E6 Obstetrics Williams pp. 73-95, 77-91

Practise the full BTSC 3 August 2025

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