October is Placenta Accreta Awareness Month. Dr. Patrick Ramsey is a maternal-fetal specialist at University Health. He answers common questions about placenta accreta, a complication that can occur during pregnancy that could be life-threatening for mom and baby.
University Hospital is a level IV maternal center and provides the highest level of obstetrics care to women with high-risk pregnancies.
What is placenta accreta?
The placenta provides nutrients and support to a fetus during pregnancy. After your baby is born, the placenta detaches from the uterine wall and gets delivered. Placenta accreta happens when the placenta is attached too deeply to the uterus.
In cases of placenta accreta, because the placenta erodes into the wall of the uterus, when delivery occurs, the placenta does not completely come out. This can lead to massive life-threatening bleeding.
Early recognition and delivery planning is critical for women with this pregnancy complication to prevent serious harm to mother and baby.
Who is at risk for placenta accreta?You’re at a higher risk for placenta accreta if you:
- Have had previous surgery on the uterus, including cesarean sections
- Have been pregnant before
- Are 35 or older
- Have abnormal placenta position
- Have placenta previa noted on an ultrasound
- Have a history of endometrial ablation
- Prior uterine curettage (dilation and curettage or dilation and evacuation)
- Have a history of Asherman syndrome
- Previous uterine myomectomy
Is placenta accreta common?
The incidence of placenta accreta is increasing in the United States, with current incidence around 1 in 300 deliveries (0.3%). This is significantly higher than two decades ago when the incidence was around 1 in 3000 deliveries (0.03%).
The significant increase in this pregnancy complication likely has resulted from a number of factors including:
- Increased use of cesarean delivery
- Older women attaining pregnancy
- Increase use of in vitro fertilization
What are the symptoms of placenta accreta?
Often there are no signs or symptoms of placenta accreta. Bright red bleeding during the third trimester could mean that something is wrong with the placenta.
How is placenta accreta diagnosed?
Placenta accreta is best diagnosed by an ultrasound performed by a provider with experience in evaluating for placenta accreta. These providers are usually maternal fetal medicine specialists who have spent three additional years of training specifically to identify abnormalities of the placenta, fetus and uterus.
There are certain ultrasound findings which are looked for which can raise concern for placenta accreta. These include:
- Large vascular lakes in the placenta
- Thin uterine wall
- Placental bulge in the bladder
- Large blood vessels connecting the placenta to the bladder
In some cases where placenta accreta is suspected, an MRI may be ordered as an additional assessment.
Are there different types of placenta accreta?
The different types of placenta accreta are related to how deeply the placenta is attached to the uterus.
- Placenta accreta happens when the placenta attaches to the wall of the uterus.
- Placenta increta occurs when the placenta goes through the uterine wall into the muscle.
- Placenta percreta happens when the placenta goes through the outer wall of the uterus and attaches to outside organs.
What is the treatment for placenta accreta?
If the placenta accreta is not treated properly, it can result in severe health problems and even death for the baby, the mother or both. In some cases, early delivery or hysterectomy are necessary to reduce complications.
Is placenta accreta preventable?
Yes and no. The only potential way to prevent placenta accreta is to avoid having the initial cesarean delivery or uterine surgery as these are the strongest risk factors. There are no other interventions known at this time to prevent placenta accreta.
Do you have to deliver early?
Yes. If you are suspected or known to have a placenta accreta, delivery between 34- and 36-weeks’ gestation is recommended. This is to avoid going into labor, which could result in serious, life-threatening bleeding.
In general, women who have placenta percreta will deliver around 34 weeks' gestation. Other types of placenta accreta delivery may be at 35-36 weeks.
In some cases, if there are recurrent bleeding episodes, preterm labor contractions, or high concern for invasion of the placenta outside of the uterus, delivery earlier than 34 weeks is sometimes recommended.
Is bedrest required?
Not necessarily. Bed rest has not been shown to be beneficial for the care for women with most pregnancy complications. If you have recurrent episodes of bleeding or recurrent preterm contractions, sometimes bedrest may be recommended.
In cases where a placenta accreta is associated with a placenta previa, pelvic rest (no vaginal sex, nothing in vagina) is strongly recommended to avoid disruption of the placenta which could cause life-threatening bleeding.
Will placenta accreta affect my child’s development during pregnancy?
No. The placenta accreta itself will not cause any concerns for your baby’s development during pregnancy. Even though early delivery is recommended for women with placenta previa, delivery usually occurs at a gestational age range (≥34 weeks) where the risk for the baby to have major problems or developmental issues is very low.
Can I get pregnant again if I’ve had placenta accreta?
Unfortunately, in most cases where there is clear evidence of placenta accreta, a hysterectomy is needed to minimize blood loss and prevent complications for you and your baby. If you have a hysterectomy, you would be unable to have any additional children.
In cases where the diagnosis if uncertain, our teams still prepare completely for your delivery, but will assess at the time your baby delivers to see if there is evidence of placenta accreta – and if not, they may not need to perform a hysterectomy. In this case you would be able to have future children but may be at higher risk for placenta accreta in your next pregnancy.
University Hospital is a Level IV Maternal Center
As a Level IV maternal center, University Hospital is capable of caring for moms with high-risk pregnancies and their babies. Trust our team to provide poised, expert care for the most complex cases.
Evidence suggests that the best outcomes for women with placenta accreta is when the woman is delivered at a high level (level IV is the highest) maternal center that has an established team with experience in the evaluation, diagnosis, pre-operative planning and management.
Placenta Accreta Team at University Health
Our placenta accreta team at University Health has a comprehensive team of providers who specialize in the care for women with placenta accreta. We have the most comprehensive range of specialists and subspecialists of any maternal care center in South Texas.
In addition, all of our providers are under one roof, available 24/7 for any urgent delivery needs, and provide the highest level of maternal care in the region. We have integrated a strong family-centered approach to the care for families who delivery at University Health.