Placenta accreta

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.