Sticky Wicket: A Case of Abnormal Placental Invasion

Background:

Invasive placentas (acreta, increta, percreta) occur when all or part of the placenta attaches abnormally to the myometrium.  Because of the abnormal attachment, invasive placentas are associated with an increased risk for massive bleeding and organ damage. Disruption of the family unit due to possible long-term hospitalization, impact on fertility and potential morbidity and mortality are additional complications associated with this high-risk condition.  It is imperative that nurses understand processes and plans, and appreciate the physical and emotional impact of this diagnosis in order to provide holistic care to the mother/family. 

Case:

This presentation will highlight a patient with a placenta percreta who experienced lengthy hospitalization both antepartum and postpartum to safely manage the risk associated with placenta percreta.  Diagnosis was made through ultrasound and verified through MRI.  Antepartum management included close fetal surveillance, medications to increase hemoglobin, consultations with ancillary specialities and in depth care planning for delivery and postpartum management.  After delivery, placenta remained in situ and neoplastics agents were delivered to decrease placenta size.  Patient ulitimately received a hysterectomy, but this was accomplished in a controlled environment that presented minimal bleeding risk to patient.

Conclusion:

Nurses play a key role in multiple aspects of care for the patient with an invasive placenta. As educator, the nurse instructs the patient/family regarding diagnosis, management options, impact on future fertility and possible complications. As member of the multidisciplinary team, the nurse is responsible for advanced planning of personnel, equipment and resources to promote safety at delivery.  As navigator, the nurse collaborates with all members of the multidisciplinary team to ensure that patient/family wishes are honored, advanced consultations are achieved and the patient’s physical/emotional/spiritual needs are met.  As direct care provider, the nurse possesses a keen knowledge base, meticulous assessment and prioritized intervention skills to care for this potentially life threatening condition. Strategies such as checklists, care planning meetings that address the continuum of perinatal care, direct team planning and tools to prevent/minimize maternal/fetal complications will be discussed.

Keywords:

Placenta percreta; Nursing role; Advanced planning; Postpartum care