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Placenta Accreta

Placenta accreta occurs when the placenta grows too deeply into the uterine wall during pregnancy. In a normal pregnancy, the placenta will detach from the uterine wall after a woman gives birth. When placenta accreta occurs, a portion or all of the placenta remains attached.

Placenta accreta is a significant problem, and excessive blood loss, hemorrhage, or other complications may occur after the delivery.

What causes placenta accreta?

Doctors don’t know the exact cause of placenta accreta, but research suggests that abnormalities in the lining of the uterus may increase the risk of the condition developing. Women who have previously undergone a C-section or other type of uterine surgery may develop scarring that increases their risk.

Some other risk factors for placenta accreta include pregnancy in women over the age of 35 and undergoing multiple pregnancies, as the risk increases with each successive pregnancy.

The position of the placenta may also increase the risk of placenta accreta, where the placenta wholly or partially covers the pregnant woman’s cervix or rests in a low position in the uterus. A placenta that covers the cervix is known as placenta previa.

A rare condition known as Asherman’s syndrome may also increase a woman’s risk of experiencing placenta accreta. Asherman’s syndrome occurs when scar tissue forms in the uterine cavity.

Scar tissue may be medically diagnosed as intrauterine adhesions. Women with a history of fibroids and past procedures to remove fibroids could also experience a higher risk of placenta accreta.

Data from the International Journal of Obstetrics & Gynaecology (BJOG) indicates that smoking may increase the risk of placenta previa. Placenta previa may eventually lead to placenta accreta.

What are the symptoms of placenta accreta?

Women who experience a pregnancy complication like placenta accreta may not experience any signs or symptoms of the condition during pregnancy.

In some women, vaginal bleeding may occur in the third trimester. Most women will not experience any signs of placental abnormalities in the first or second trimester.

When is placenta accreta usually diagnosed?

Diagnosis of placenta accreta may occur during a routine ultrasound, but not always. Doctors will carefully examine women who have risk factors for placenta accreta by looking at the implantation of the fetal placenta.

Some doctors may perform a magnetic resonance imaging (MRI) test for enhanced results. Early detection of placenta accreta may help the mother avoid life-threatening complications, such as hysterectomy (removal of the uterus) or hemorrhaging.

How is placenta accreta treated?

After a diagnosis of placenta accreta, a woman’s obstetric doctor will conduct an examination each month to determine the course of care. Due to the risk of early labor, a health care team may give the mother steroids, which can reduce problems in premature babies.

Doctors often recommend that women with placenta accreta should deliver their baby between 34 and 36 weeks, which is at least a month before a traditional due date. Delivering early can reduce the risk of life-threatening complications for the mother and baby. Doctors also suggest that women reside close (no more than 30 minutes) to their medical team so that doctors can take quick action in the event of early labor.

Women who experience vaginal bleeding during the third trimester might need to enter the hospital early. Other women might need to consider pelvic rest (abstaining from sex).

Can doctors or a pregnant woman prevent placenta accreta?

Unfortunately, no remedies exist to prevent any of the conditions along the placenta accreta spectrum. Working in tandem with the Society for Maternal-Fetal Medicine in 2015, The American College of Obstetricians and Gynecologists (ACOG) created a list of recommendations for women experiencing a high-risk pregnancy and the threat of placenta accreta.

Doctors designed this system of care to foster healthy gestation throughout the pregnancy and to reduce the incidence of maternal morbidity during or after a placental invasion. Recommendations included a multidisciplinary approach to care from health care professionals in areas like cardiology, gynecology, hematology, and critical care.

How do you remove placenta accreta?

In severe cases of placenta accreta, a woman’s health care team might need to perform a Cesarean section followed by a hysterectomy. A Cesarean hysterectomy may help prevent hemorrhaging and other postpartum complications.

The risk of life-threatening blood loss due to the separation of the placenta from the uterine wall may force doctors to perform a hysterectomy. Some women may require time in the intensive care unit (ICU).

What are the complications with placenta accreta?

Hemorrhage icon

Feeding problems

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Hearing and vision problems

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Hemorrhaging after delivery is the most severe complication of placenta accreta. Vaginal bleeding may cause a condition called disseminated intravascular coagulopathy, which prevents the blood from clotting normally.

Heavy bleeding may also cause lung failure or kidney failure in the mother, and women who experience this complication may require a blood transfusion after they give birth.

Placenta accreta may also cause a woman to enter labor early and result in premature birth. Bleeding that occurs during pregnancy rather than after birth may cause preterm labor. Doctors may require a Cesarean delivery in a placenta accreta emergency.

When is placenta accreta considered a medical emergency?

Given the danger of life-threatening complications from placenta accreta and the risk of maternal death, women who experience bleeding in their third trimester should seek medical help immediately, especially if they’ve had a diagnosis on the placenta accreta spectrum.

What is the placenta accreta spectrum?

Placenta accreta is diagnosed by three stages of severity based on how deeply the placenta has grown into the uterus. The first stage is placenta accreta, when the placenta grows into the lining of the uterus. The second stage is placenta increta, when the placenta reaches the wall of the uterus and grows into it.

Placenta percreta is the third stage and occurs when the placenta grows through the wall of the uterus. Sometimes, the condition may allow the placenta to expand into other organs near the uterus, such as the colon or bladder.

What is the death rate for placenta accreta?

As high as 7%

mortality rate for placenta accreta, according to a research article published by the Acta Obstetricia et Gynecologica Scandinavica, an international medical journal. The study found that most of the deaths analyzed were preventable. Common causes of death included hemorrhaging and failure to diagnose.

Man and pregnant wife

If you or a loved one experienced health complications or death as a result of placenta accreta, doctor negligence may have been a contributing factor. You should receive the compensation you deserve for injuries caused by medical malpractice. To discuss your case with a compassionate and knowledgeable lawyer at Birth Injury Center, contact us today for a free consultation.

Written by:
Birth Injury Center Team

The Birth Injury Center aims to create informational web content and guides to help women and their families seeking support and guidance for birth injuries caused by medical negligence. All of the content published across The Birth Injury Center website has been thoroughly investigated and approved by medical expert Natalie Speer, RNC-OB, Attorney Ryan Mahoney.