Acrestismo placentário é quado a placenta se fixa profundamente na parede uterina, ultrapassando o limite normal de fixação. Ela pode ser classificada em acreta (quando está inserida profundamente na decídua – camada interna do útero), increta (quando chega a musculatura uterina) ou percreta (quando ultrapassa a musculatura uterina podendo invadir até órgãos adjacentes, como a bexiga).
A decídua (camada mais interna do útero gravídico) é constituída por duas camadas: uma camada mais externa, chamada de esponjosa e outra mais interna, chamada de compacta. Tal conformação tem especial importância no momento após o parto em que ocorre o despendimento da placenta (chamado de dequitação). Por ser constituída por tecido frouxo (semelhante a um rendilhado), a camada esponjosa facilita a separação natural da placenta logo após ao parto.
O acretismo placentário é uma patologia não fuito frequente, afetando cerca de 1 a cada 2.500 partos. A placenta acreta é muito raramente reconhecida antes do nascimento, sendo muito difícil de ser diagnosticada. Enquanto ela pode causar algum sangramento vaginal durante o terceiro trimestre, ela é mais comumente associada com os fatores que desencadeiam a condição.
Após o parto, a placenta geralmente se despreende da parede uterina de forma relativamente fácil. Nos casos de acretismo não existe plano de clivagem entre a placenta e a parede uterina o que dificulta e às vezes até torna impossível o desprendimento da placenta, podendo causar grave hemorrgia no período após o parto.
O tratamento do acretismo placentário vai depender da situação encontrada. Na maioria dos casos o descolamento é mais difícil, entretanto é possível resolver o problema com uma curetagem uterina. Nos casos mais graves poderá ser necessária a realização de cirurgia de histerectomia, com retirada do útero. Nos casos de placenta percreta poderá ser necessário intervenção cirúrgica nos órgãos comprometidos, como bexiga e intestino. Alternativamente poderá ser realizado o parto deixando-se a placenta aderida ao útero. Nestes casos usa-se uma medicação chamada de metotrexate, que deve reduzir progressivamente o tamanho da placenta.
O principal fator de risco é a placenta prévia. Cerca de 10% das placentas prévias possuem algum grau de acretismo. Outros fatores de risco incluem a presença de cicatriz uterina prévia (cesárea) e curetagem uterina prévia.
Tipos de acretismo placentário. Fonte: http://portalcodgdh.min-saude.pt/index.php/Ficheiro:Acreta.PNG
Diagnóstico
A placenta acreta é muito raramente reconhecida antes do nascimentos, sendo muito difícil de ser diagnosticada. Enquanto ela pode causar algum sangramento vaginal durante o terceiro trimestre, ela é mais comumente associada com os fatores que desencadeiam a condição. Em alguns casos pode-se observar níveis séricos aumentados de
alfa-fetoproteína, embora isso possa ser um indicador de muitas outras doenças.
Quais são os riscos para o bebê?
A maior preocupação com relação ao bebê é geralmente relacionado com a prematuridade. A
placenta prévia comumente se localiza no segmento uterino e pode provocar sangramentos e determinar a necessidade de um parto antes da data prevista.
Quais são os riscos para a mãe?
Usualmente é mais difícil de separar a placenta do útero. O médico pode se defrontar com um sangramento abundante durante o período em que a placenta é removida. Este sangramento poderá colocar em risco a vida da mãe e eventualmente será necessária uma histerectomia (retirada do útero) para controlar o sangramento. Entretanto é importante observar que existem diversos graus diferentes de acretismo, e muitas vezes o procedimento de retirada da placenta pode ser simples.
Não existe tratamento específico para a placenta acreta. Seu médico poderá recomendar repouso durante a gestação para evistar sangramentos.
Fonte: Fetalmed
Este artigo pertence ao http://gestavida.blogspot.com/
Plágio é crime e está previsto no artigo 184 do Código Penal.
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