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Placenta accreta is a pregnancy complication that happens when the placenta, responsible for the nutrients and oxygen of a developing fetus, attaches too deeply into the uterus and remains after delivery.
In a normal pregnancy, the placenta that grows in the uterus is separated from the uterine wall after giving birth and is pushed to the birth canal during labor contraction. It is when the placenta fails to detach from the uterine wall that a condition called placenta accreta occurs.
One major complication is heavy bleeding which can be life-threatening to the baby and the mother. However, when diagnosed early or before birth, risks can be managed. Healthcare provider may recommend a cesarean section (C-section) followed by a hysterectomy to prevent dangerous bleeding.
The risk associated with placental conditions depends on how deep the placenta has embedded in the uterus.
- Placenta increta: occurs when the placenta has attached firmly and affected the muscles in the uterus.
- Placenta percreta: the placenta has grown through the uterus and can impact nearby organs such as the intestine and bladder.
Symptoms
In some cases of placenta accreta, vaginal bleeding in the third trimester of pregnancy can happen. Bladder or pelvic pain may be felt in severe cases such as placenta percreta.
Generally, placenta accreta may not have visible signs and symptoms throughout the pregnancy. It is often diagnosed during a scheduled ultrasound.
Causes
Placenta accreta develops due to several reasons. Commonly, it can be from scarring after multiple C-sections or other uterine surgeries. Having these surgeries can cause damage in the uterine lining which increases the risk for placenta accreta. In some cases, placenta accreta may still develop even without having uterine surgery or known cause.
Risk factors
The following factors increases the risk of having placenta accrete:
- History: Having a previous surgical procedure for the uterus, such as multiple C-sections or other uterine surgeries increases the risk of placenta accreta.
- Age: Women who get pregnant at the age of 35 or above have a higher tendency of having placenta accreta.
- Position of the placenta: A higher chance of developing placenta accreta if the placenta is partially or completely covers the cervix (placenta previa) or it attaches in the lower segment of the uterus.
Diagnosis
Placenta accreta can be detected through an ultrasound during the pregnancy. If a woman has a high risk of having placenta accreta, further imaging such as magnetic resonance imaging (MRI) can be helpful to gather more information and confirm the diagnosis. The tests will show the placenta and how it is attached the uterine wall.
In some case, placenta accreta will not be detected earlier and is only known after birth. Women who have a placental disorder called placenta previa wherein the placenta blocks the cervix, and those that have undergone uterine surgery should inform their doctor and be on lookout for signs of placenta accreta during ultrasound.
Treatment
The treatment plan and birth plan vary for every patient. The doctor will evaluate the severity of the condition and discuss the treatment options with the patient to ensure successful delivery.
If a woman experienced vaginal bleeding in the third trimester or was diagnosed with placenta previa, hospitalization and bed rest may be recommended to prevent preterm labor.
Severe cases of placenta accreta commonly requires surgery. A procedure known as cesarean hysterectomy, aids in minimizing the risk of fatal blood loss that can happen during delivery. This procedure involves removal of the uterus after the C-section delivery. The ovaries are often kept in place to prevent early menopause on mothers.
- Before surgery
- Close monitoring by the doctor is important in preparation for the surgery. A multidisciplinary medical team consists of an obstetrician and a gynecologist, a subspecialist in pelvic surgery, anesthesiologist and pediatrician, which is necessary to ensure the safety of the mother and the baby.
- Complications associated with the surgery will be discussed by the doctor, as the patient will need to be informed of all possible emergency procedures such as blood transfusion during and after surgery and admission to the intensive care unit in the event of uncontrolled bleeding.
- During surgery
- Cesarean hysterectomy starts with a C-section delivery followed by a hysterectomy. For women who had an early diagnosis of placenta accreta, C-section is scheduled between 34 to 37 weeks.
- C-section involves doing an incision in the abdomen and uterus to deliver the baby after which, hysterectomy or removal of the uterus is done, with the placenta still attached to it. This is the safest option to minimize the risk of hemorrhaging. After the hysterectomy, pregnancy is no longer possible.
- For women who choose to avoid hysterectomy, they may opt for the removal of most of the placenta but still leaving a piece of it attached in the uterus, but this can lead to complications such as excessive vaginal bleeding, infection, blood clots and difficulty in pregnancy and may result in having hysterectomy in the future.
