placenta increta

Placenta increta is part of the placenta accreta spectrum (PAS), which includes accreta (villi adhere to myometrium), increta (villi invade into myometrium), and percreta (villi penetrate through myometrium to serosa/adjacent organs). The condition results from defective decidualization and abnormal trophoblastic invasion, often associated with prior uterine surgery, particularly cesarean sections, which create areas of scarred endometrium with poor decidual formation. Risk factors include previous C-sections, placenta previa, advanced maternal age, multiparity, prior uterine procedures, and Asherman syndrome. Diagnosis is made via ultrasound showing loss of the hypoechoic retroplacental zone, irregular vascular lacunae, and abnormal color Doppler findings, with MRI used for confirmation when ultrasound is inconclusive. Management requires multidisciplinary planning with maternal-fetal medicine, anesthesia, blood bank, and surgical teams. Delivery typically occurs via scheduled cesarean section at 34-35 weeks after steroid administration, with preparations for massive transfusion and possible hysterectomy. Conservative management with methotrexate may be attempted in select cases, but definitive treatment often requires cesarean hysterectomy due to the high risk of life-threatening hemorrhage during placental separation attempts.