Placenta Accreta

A Growing Problem for Mothers

Your placenta is the gateway to your baby, filtering and delivery oxygen- and nutrient-rich blood through the umbilical cord. This disc-shaped organ is created from the same cells as your unborn baby and attaches to the uterus wall around week 7–12 of pregnancy (though it can shift in position as the uterus expands).

What happens when the placenta attaches too deeply to the uterus wall? That’s placenta accreta. It strikes 1 in 533 pregnancies; but the risk increases the more C-sections a mother has had.

The Dangers of Placenta Accreta

Placenta accreta, generally speaking, is an abnormal implantation of the placenta. During pregnancy, a thick layer of specialized mucous called decidua lines the uterus wall. In the final stage of pregnancy, the decidua and placenta detach and are shed as afterbirth. In placenta accreta, the placenta attaches itself directly to the uterine wall, the myometrium, without the deciduas to protect it. Scars or damage to the uterine wall seem to allow the placenta to invade it.

Any form of placenta accreta is a high-risk pregnancy complication.

For the mother, it leads to a serious risk of severe postpartum bleeding, postpartum fever, and uterine rupture. The maternal death rate for undiagnosed placenta accreta is around 7%. For the baby, there’s a danger of premature delivery and other complications, including asphyxia or even death.

There are three different levels of placenta accreta, depending on how deep the placenta’s villi (blood vessels) are implanted. They are increasingly dangerous:

• Placenta accreta: When the placenta attaches too deeply to the uterine wall, but does NOT penetrate the uterine muscle. This is the most common form of accreta, at 75% of cases.
• Placenta increta: When the placenta fixes itself deeper, into the uterine muscle. This accounts for around 15% of cases.
• Placenta percreta: When the placenta penetrates through the uterine wall and attaches to another organ (usually the bladder or bowels). Rare, accounting for 5% of cases.

These complications usually demand a C-section delivery followed by immediate hysterectomy. Babies are delivered as soon as possible, as early as week 34.

The Increasing Risk of Placenta Accreta

The rate of placenta accreta seems to be increasing along with the rate of C-sections in the United States. In 2015, 32% of all deliveries were by Cesarean section—and it’s expected that about one-third of births every year will continue to be by C-section.

Sometimes, a C-section is necessary and proper to save the life of a baby. But placenta accreta will continue to rise. There is also a strong association with placenta previa: 60% of accreta cases involve previa.

The following are risk factors for an abnormal implantation of the placenta. Most involve some form of myometrial (uterine wall) damage:

• Placenta previa
• Previous Cesarean section
• Previous abortion
• Previous D&C
• Uterine structure defects
• Older mother

By opting for a natural birth (especially if you are planning to have more children in the future), you can decrease your risk of placenta accreta. Your doctor should discuss these risks with you fully and inform you of your options, including vaginal birth after Cesarean (VBAC).

Don’t be pressured into scheduling a C-section to fit your doctor’s timetable.

Diagnosing and Treating Placenta Accreta

We cannot stress how important diagnosis is for cases of placenta accreta. The American College of Obstetricians and Gynecologists calls it “…a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management.” As reported in one placenta accreta case, gynecologic oncology, interventional radiology, urology, neonatal intensive care, a blood bank, anesthesiology, nursing, and critical care staff were all in place for successful C-section delivery. The mother had to have a hysterectomy, but her baby was fine.

Preparation is vital to treating placenta accreta. It’s usually detected on a routine ultrasound, but vaginal bleeding in the third trimesters is a symptom. Imaging tests like MRI and blood tests can also be performed if risk factors are present, and should be if you or your doctor suspects this condition.

You need a hospital that is fully equipped to handle your placenta accreta—not all facilities have the resources to handle cases of placenta accreta. Do your research and ask questions! This is a dangerous condition, but both mother and baby can and should come out safe in the end.

If Something Went Wrong

If your doctor or medical provider didn’t diagnose or manage a serious case of placenta accreta, he or she could be guilty of medical malpractice. An unexpected hysterectomy, even to save a mother’s life, can be emotionally devastating if she wants more children. Or perhaps your baby was injured, and he will need lifelong care.

Birth injury attorney Laura Brown has dedicated her time and energy to helping children and families who suffer from preventable medical mistakes.