••• Chapter 12^ Obstetric Complications^115
❍ What is the difference between placenta accreta, increta, and percreta?
Accreta: Placental villi are attached to the myometrium with absent Nitabuch layer.
Increta: Invasion of placental villi into the myometrium.
Percreta: Invasion penetrates thru the full thickness of the myometrium.
❍ How sensitive is U/S for placenta accrete?
79% (95% positive predictive value).
❍ What are the pathognomonic findings of placenta accreta on U/S?
Irregular shaped placental lacunae within the placenta, “Swiss cheese” or moth-eaten” appearance.
❍ What is the technique for replacement of the uterus in an inverted uterus when replacement is refractory
to manual replacement?
Huntington technique: Perform a laparotomy with a tenaculum placed on the uterus to sequentially replace the
fundus. If the cervical band is too tight, use the Haultain technique. This is incising the ring posteriorly (to avoid
the bladder) and correct the inversion.
❍ Most fetal survivors of a perimortem C/S are delivered within what time frame?
5 minutes of cardiac arrest.
❍ What are the two leading causes of anesthesia-related maternal morbidity and mortality?
Failed intubation and pulmonary aspiration.
❍ What is the recurrence risk of shoulder dystocia?
1% to 16.7%
❍ What is the advantage of placing heroin-addicted pregnant women on methadone during pregnancy?
(1) It avoids the risks of STDs such as HIV and hepatitis from IV drug use.
(2) It decreases the risk of intrauterine demise from cyclical withdrawal.
❍ What is the incidence of conjoined twins? When does the embryonic division occur in conjoined twins?
1 /50,000 births days 13 to 15 after fertilization.
❍ Who should be tested for antiphospholipid antibody syndrome?
(1) History or current diagnosis of vascular thrombosis.
(2) Pregnancy complications
(a) 1 or more unexplained fetal death >10 weeks.
(b) 1 or more premature birth secondary to preeclampsia before 34 weeks.
(c) 3 or more consecutive spontaneous abortions before 10 weeks.
❍ What are the three tests to screen for to diagnose antiphospholipid antibody syndrome?
Lupus anticoagulant, anticardiolipin antibodies, and anti-beta 2 glycoprotein I antibodies.