Placenta accreta is a serious, potentially life-threatening pregnancy complication that is on the rise worldwide, especially as C-sections (Cesarean sections) have become increasingly common over the past few decades.
If diagnosed in time, though, this condition doesn't mean you can't have a healthy baby. So, what exactly is placenta accreta — and what do you need to know about it? Read on to find out who's at risk and why prompt medical attention is so important.
What is placenta accreta?
Placenta accreta happens when the placenta attaches too firmly to the uterine wall. In a typical pregnancy, the placenta attaches to the uterine wall during pregnancy but detaches easily during childbirth.
When placenta accreta occurs, the blood vessels and other tissue from the placenta grow more deeply into the tissue of the uterus. This makes it more difficult for the placenta to detach, and can cause bleeding during the third trimester and possibly dangerous hemorrhaging (blood loss) during delivery.
There are different types depending on how deeply the placental cells have grown.
- Placenta increta is when the placenta embeds more deeply into the wall of the uterus, reaching the muscle.
- Placenta percreta, the most severe type, is when the placenta has grown all the way through the uterine wall, sometimes into surrounding organs, including the bladder.
What causes placenta accreta?
The condition is thought to be a complication caused by scarring or other abnormalities on the uterine wall, from a C-section or other types of uterine surgery, such as fibroid removal, for example. Women who have had C-sections are more likely to have placenta accreta than women who have had vaginal deliveries.[1] Plus, the more C-sections you've had, the greater your chances of having placenta accreta.
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That said, it also can happen in women who don't have any known risk factors.
What are the symptoms of placenta accreta?
Some women may have bleeding during the third trimester, but usually, placenta accreta doesn't cause any signs or symptoms.[2]
Who is most at risk for placenta accreta?
Women who have had one or more previous C-section deliveries (or any other uterine surgery) are at an increased risk for placenta accreta due to scarring of the uterine wall. According to the National Accreta Foundation, the estimated incidence of placenta accreta has quadrupled since the 1980s, from 1 in 1,250 births to 1 in 272 births.[3]
The more C-sections you've had, the higher your risk. Other risk factors include a full or partial placenta previa (when the placenta is near or covering the cervix), a maternal age of 35 or higher and uterine conditions such as endometriosis and fibroids.
How is placenta accreta diagnosed?
Typically, placenta accreta is diagnosed with an ultrasound during a routine prenatal checkup. Doctors often want to do an MRI (magnetic resonance imaging) if they suspect accreta but can't tell for sure with the ultrasound, or if you're at an increased risk for the condition. By using ultrasound or MRI technology, doctors can determine how deeply into the uterine wall the placenta is attached.
If you are diagnosed with placenta accreta, you'll likely have a team of doctors working with you during your pregnancy (including surgeons and anesthesiologists) to prevent too much blood loss or other complications from occurring.
Placenta accreta warning signs to look out for
If you notice any third-trimester bleeding or spotting, see your health care practitioner right away. There's a chance that your doctor will tell you to abstain from sex (called pelvic rest) or to go to the hospital.
Possible complications of placenta accreta
Placenta accreta can increase the risk of serious vaginal bleeding and hemorrhaging after a delivery, which may require a blood transfusion. Though extremely rare, it's also possible to experience a condition in which your blood doesn't clot normally (disseminated intravascular coagulation), lung failure or kidney failure.
How is placenta accreta treated?
If the condition is diagnosed in time, you and your health care practitioner should develop a birth plan that allows for the safest delivery for both you and your baby, along with a contingency plan for an emergency spontaneous delivery. A scheduled C-section before your due date — as early as 34 weeks — is almost always the recommended route, since this lowers the risk of bleeding from contractions or labor.
Unfortunately, the C-section will usually — though not always — be followed by a hysterectomy (surgical removal of the uterus) with the placenta still attached, which may be the best option to keep you safe and prevent life-threatening blood loss. If you don't have a hysterectomy, you may be more likely to have complications, including placenta accreta, in the future.
While it may make delivery more challenging, the extra precautions and interventions can ensure that you stay safe and that your bundle of joy is born perfectly healthy.
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