False and true increment of the placenta

In some cases, obstetrician experiencing difficulties detachment of the placenta from the uterine wall, which depend on either of the changes available in the wall of the uterus itself, or from the specific structure of the placenta (webbed, regional and incremental placenta - placenta membranacea, marginalis, succenturiata).
Individual pathological form attachments placenta to the wall of the uterus known firmly attached - accrete the afterbirth (placenta adhaerens), fused the afterbirth (placenta accreta) and sprouted placenta, when there is a deep ingrown CVS between muscles (placenta increta); all of these forms are at different stages of the same pathological process of germination of the villi in the wall of the uterus with a sharp changes decidua basalis. On the basis of histological studies have found that when accrete the afterbirth (placenta adhaerens) chorionic villi are intimately connected with spongy layer, but for the most part does not vest in the basal layer (decidua basalis). When accrete the afterbirth (placenta accreta) villi, as a rule, gives the basic layer of mucous membrane, reaching the muscle layer of the uterus, and in some areas even penetrating into it. Finally, when sprouted the afterbirth (placenta increta) fibers embedded in the muscle tissue of the uterus.
In-depth introduction villi in the wall of the uterus, according to efficiency UNESCO-Stroganov, connected with the decrease of the biological properties of the decidual tissue, which has protective properties against the destructive effect of chorion. Neumann believes that, in addition to lowering the biological properties of the endometrium, is set to reduce blood substances, oppressive action of enzymes produced by trophoblasts.
Cause deep germination CVS is probably very significant enzymatic activity of the epithelium of the chorion and the reduced capacity of the mucous membrane of the uterus to develop appropriate protective substances.
Studies have shown I. E. Marichevoy made it to our Department, the relative increase of enzyme activity CVS and reduction of the biological properties of the decidual tissue are in close connection with changes in the activity of hyaluronidase in the placenta and the mucous membrane of the uterus. The concentration of hyaluronidase in the placenta, equal to 0.2-0,24 conventional units, provides physiological balance biological systems - hyaluronic acid - hyaluronidase. With decreasing activity gialuronidasy (0,7-0,8) bonding and cementing properties of hyaluronic acid increase; increase in the activity of hyaluronidase (0,005), on the contrary, these properties of hyaluronic acid decreases, resulting NAP can penetrate deeply into the uterine wall, and sometimes germinate; the result will be the emergence plasenta increta.
Thus, these studies show that one of the reasons of occurrence of pathological forms of placental attachment is the change of the activity of the enzyme hyaluronidase.
When false increment of the placenta (pi. adhaerens seu accreta spuria) between the placenta and muscle wall of the uterus there is a very unstable fabric or only a layer of fibrin. In such cases, to remove the placenta is usually possible. Manual separation of the placenta proves to be ineffective in cases of real increment (incrementum placentae verum, s. placenta increta).
True full increment of the placenta is very rare. A. D. Dmitriev 24 506 childbirth seen one case of real increment.
Bleeding placenta increta usually not the case. The only viable therapy for this complication is high (supracervical) amputation of uterus. Operation manual offices in the real increment of the placenta is extremely dangerous and useless interference; mortality when it is 66.6 %.
At partial increment of the placenta, which occurs very rarely, sometimes, may be quite a strong maternal bleeding from vessels located at the placental site, from the so-called majorsince spaces.
The increment of the placenta due to deep structural-anatomic changes in the falling shell, mainly degenerative and atrophic nature, which in simpler cases, cause the destruction of all spongy and part at all compact layers falling shell, and in more severe - the destruction of all the falling shell that helps ingrown hairs in the uterine musculature.
The emergence of this pathological process contribute to: 1) infectious processes in mucous membrane; 2) mechanical injury mucosa (energetic curettage of the uterus); 3) the scar after cesarean section (rarely); 4) fibromyoma (aplasia of the mucous membranes); 5) the defective development of the cervix and endometrium; 6) syphilis and malaria; 7) placentation in the area of the neck or neck; 8) jade.
According to the observations of A. Krasnopolsky, abortion and post-abortion cause disease in the uterus great changes that predispose to the increment of the placenta.
Particularly noteworthy are extravasate and apoplectically tricks in the fruit part of the placenta, clusters unstructured a homogeneous mass, layers of fibrin with dying in them nuclei syncytium and especially white heart attacks, which can lead to a very strong connection placental tissue from the uterine wall. Equally important is the retroplatsentarno bleeding that can occur in the first half of pregnancy.
The increment of the placenta is often combined with previa or by attaching near uterine opening of a tube.
At partial increment of the placenta is usually manual separation and only in difficult cases, resort to stupid curette.
If the separation of the placenta is made with great effort, often together with villi detached particles muscles and can even break through the wall of the uterus. At the break of the uterus and bleeding into the abdomen shows chrevosechenie (supracervical amputation or total hysterectomy).