Which of the following types of placenta complicates third stage of labour and is associated with a past history of caesarean section: September 2011
**Question:** Which of the following types of placenta complicates the third stage of labour and is associated with a past history of caesarean section?
**Core Concept:** The third stage of labour includes the delivery of the placenta, which is also known as the afterbirth. There are different types of placentas that can complicate this process. In the context of a history of caesarean section, the placenta is more likely to be abnormally invasive placenta (AIP).
**Why the Correct Answer is Right:** Abnormally invasive placenta (AIP), also known as placenta accreta, increta, or percreta, is a type of placenta that arises from the abnormal invasion of the trophoblastic cells into the myometrium, subserosa, or serosa, respectively. In this scenario, the placenta does not separate easily from the uterus during the third stage of labour, leading to complications like heavy bleeding, blood loss, and potential maternal mortality if not appropriately managed. Given a history of caesarean section, the placenta is more likely to be AIP because the previous caesarean section increases the risk of abnormal placenta implantation in subsequent pregnancies.
**Why Each Wrong Option is Incorrect:**
A. Placenta praevia: This refers to the lower segment of the uterus being invaded by the placenta, but it does not involve the entire uterus like AIP. Placenta praevia can complicate the third stage of labour without a history of caesarean section.
B. Placenta increta and percreta are similar to AIP, but the term "percreta" specifically refers to the placenta invading through the myometrium into the serosa or peritoneum. This does not address the question's focus on the connection with a history of caesarean section.
C. Placenta accreta is when the placenta invades the myometrium without reaching the serosa or peritoneum. Unlike AIP, it does not involve the entire uterus and does not necessarily correlate with a history of caesarean section.
D. Placenta praevia is associated with a history of caesarean section, but it refers to the lower segment of the uterus being invaded by the placenta, not the entire uterus as in AIP.
**Clinical Pearl:** Placenta accreta, increta, or percreta are a subset of AIP and are associated with a history of caesarean section due to the prior uterine surgery disrupting the normal decidual-endometrial interface, resulting in abnormal placental invasion of the uterine wall.
In summary, AIP is the correct answer because it involves the entire uterus and is more likely to occur after a history of caesarean section, which disrupts the normal decidual-endometrial interface, leading to abnormal placental invasion of the uterine wall. Placenta accreta, increta, and percreta are subsets of AIP. Placenta praevia