During pregnancy the suspicion of placenta accreta is based on a history of pervious cesarean births, uterine surgeries such as myomectomy or repeated D&C. A Doppler ultrasound and an MRI can give additional data of a suspected abnormal placenta, but do not provide a certain diagnosis. After birth, placenta accrete is suspected when the placenta does not spontaneously separate and does not separate in response to medications or manual attempts to remove it. The only definitive diagnosis is by pathologic examination of the placenta uterine interface to demonstrate adherence of the myometrial tissue to the maternal surface of the placenta.
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