Placenta accreta

Description

Placenta accreta is a serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall.

Normally, the placenta separates from the uterine wall after childbirth. With placenta accreta, part or all of the placenta remains attached. This can cause severe blood loss after delivery.

It is also possible for the placenta to invade the muscles of the uterus (placenta increta) or grow through the uterine wall (placenta percreta).

Placenta accreta is considered a high-risk pregnancy complication. If the condition is diagnosed during pregnancy, it is likely that you need an early delivery by caesarean section followed by the surgical removal of the uterus (hysterectomy).

Symptoms

Placenta accreta often does not cause signs or symptoms during pregnancy — although vaginal bleeding during the third trimester could occur.

Occasionally, placenta accreta is detected during a routine ultrasound.

Causes

Placenta accreta is thought to be related to abnormalities in the lining of the uterus, usually due to scarring after a c-section or other uterine surgery. Sometimes, however, placenta accreta occurs without a history of uterine surgery.

Risk factors

Many factors can increase the risk of placenta accreta, including:

  • Previous uterine surgery. The risk of placenta accreta increases with the number of cesarean section or other uterine surgery he has had.
  • The Placenta position. If the placenta partially or totally covers the cervix (placenta previa) or is located in the lower part of the uterus, you are at greater risk of placenta accreta.
  • The maternal age. Placenta accreta is more common in women older than 35 years.
  • Prior to the delivery. The risk of placenta accreta increases as the number of pregnancies increases.

Complications

Placenta accreta can cause:

  • Heavy vaginal bleeding. Placenta accreta poses a great risk of getting a vaginal bleeding (hemorrhage) after the delivery. The bleeding can cause a life-threatening condition that prevents the blood from clotting normally (disseminated intravascular coagulopathy), as well as the pulmonary insufficiency (respiratory distress syndrome of the adult), and renal failure. A blood transfusion, it will probably be necessary.
  • The preterm birth. Placenta accreta may cause labor to begin early. If the placenta accreta causes of bleeding during your pregnancy, you might need to deliver your baby early.

Placenta accreta

Diagnosis

If you have risk factors for placenta accreta during pregnancy, such as placenta, partially or completely covering the cervix (placenta previa) or a previous uterine surgery — your health care provider will carefully examine the implantation of the placenta to the baby.

Through an ultrasound or a Magnetic resonance imaging (MRI), your health care provider can assess how deeply the placenta is implanted in the uterine wall.

Treatment

If your doctor suspected placenta accreta, he or she will work with you to develop a plan to safely deliver your baby.

In the case of the extensive placenta accreta, a cesarean section followed by the surgical removal of the uterus (hysterectomy) may be necessary. This procedure, also called a cesarean section, hysterectomy, help to prevent life-threatening blood loss which can occur if there is an attempt to separate the placenta.

If you have vaginal bleeding during the third trimester of pregnancy, your doctor may recommend pelvic rest or hospitalization.

Before the surgery

Your health care team will include the obstetrician and gynecologist, subspecialists in pelvic surgery, a team of anesthesia, and a pediatric team.

Your health care provider will discuss the risks and potential complications associated with placenta accreta. He or she also could also talk about the possibility of his:

  • To have a blood transfusion during or after delivery
  • The need to be admitted to the intensive care unit after delivery if you have life-threatening bleeding

During the surgery

During the c-section, your health care provider will deliver your baby through an incision in the abdomen, and a second incision in the uterus. After the delivery, a member of your health care team will remove your uterus with the placenta still attached to prevent severe bleeding.

After a hysterectomy, you can no longer become pregnant. If you had planned additional pregnancies in the future, discuss possible options with your health care provider.

Rarely, the uterus and the placenta can be kept intact, allowing the placenta to dissolve with time. However, this approach can have serious complications, including:

  • Severe vaginal bleeding
  • Infection
  • The need of a hysterectomy at a later date

In addition, some research suggests that women who are able to avoid a hysterectomy after having placenta accreta are at risk of complications, including recurrent placenta accreta, with later pregnancies.

Coping and support

If your doctor suspects that you have placenta accreta, it is likely that you worry about how your condition will affect your birth, your baby, and, possibly, future pregnancies.

To ease your anxiety:

  • To find out about the placenta accreta. The collection of information about your condition can help you feel less anxious. Talk with your health care provider, do a bit of research, and connect with women who have had placenta accreta.
  • Prepare for a c-section. Ask questions about the procedure, pain management and expectations for recovery.
  • Prepare for a hysterectomy. After your hysterectomy, you no longer have menstrual cycles or to be able to get pregnant. Ask your health care provider about what to expect during recovery, the recovery time and how the surgery could affect your recovery after giving birth.
  • Take care of yourself. Set aside time to calm the activities that help you relax, such as reading or listening to music. Relaxation techniques, such as meditation, deep breathing, or guided imagery, may help to relieve stress and create a feeling of calm.

Preparing for your appointment

If you have vaginal bleeding during the third trimester, contact your health care provider immediately. If the bleeding is severe, seek emergency medical attention.

Often, the placenta accreta is suspected after an ultrasound early in the pregnancy. You can learn about the condition and develop a plan to manage in a follow-up visit.

What you can do

Before your appointment, you may want to:

  • Ask about pre-appointment precautions, such as activities you should avoid and symptoms that should prompt you to seek urgent care.
  • Ask a family member or a friend to join you to help you remember the information they give you.
  • Write down questions to ask your health care provider.

Some questions to ask your health care provider about placenta accreta include:

  • What is the cause of the bleeding?
  • What treatment approach do you recommend?
  • What care is needed during my pregnancy?
  • What are the signs or symptoms should cause me to call you?
  • What are the signs or symptoms should cause me to go to the hospital?
  • I'm going to be able to deliver vaginally?
  • How this condition increases the risk of complications in future pregnancies?
  • I'm going to need a hysterectomy after the baby is born?

Do not hesitate to ask other questions as they occur during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

  • When they realized the vaginal bleeding?
  • Did you bleed only once, or that the bleeding has been turned off and on?
  • How heavy is the bleeding?
  • Is the bleeding accompanied by pain or contractions?
  • Has had previous pregnancies?
  • You have had uterine surgery?
  • How much time does it take to get to the hospital in case of an emergency, including the time to arrange child care and transportation?
Symptoms and treatment of Placenta accreta