Plazentationsstörungen bei Zustand nach Sectio caesarea

摘要

Placenta previa as well as placenta accreta, increta and percreta can be summarized as abnormal placentation. While the exact pathogenensis is still unknown there is a strong association between operative procedures involving the uterus and the development of abnormal placentation. In the last decades there has been a continuous rise in the cesarean section rate. As cesarean section is one of the main risk factors for the development of abnormal placentation it is not surprising that there has been a concomitant rise in the incidence of abnormal placentation. The major morbidity associated with abnormal placentation primarily arises from poorly controlled bleeding at the time of delivery. Therefore it is essential that abnormal placentation is diagnosed before delivery. Diagnosis can be established using transabdominal and/or transvaginal ultrasound with high sensitivity and specificity. Recently the ability to differentiate placenta increta and percreta from placenta accreta as described with a sensitivity and specificity of 100 %. Early diagnosis allows adequate planning and the development of a multidisciplinary approach, which translates into reductions in blood loss, maternal morbidity and potentially maternal mortality. In the future we must therefore succeed in classifying patients as high or low risk for abnormal placentation according to the medical history. Special attention must be devoted to placental location and ultrasound appearance of the placenta. In case of abnormalities referral to a tertiary care center with expertise in the diagnosis of abnormal placentation should be organized. The ultimate goal for the future must be the prenatal diagnosis of every case of abnormal placentation, thereby allowing the development of optimal treatment plans for affected patients.