October is Placenta Accreta Awareness Month
As expectant parents, you’re embarking on an exciting journey filled with anticipation and joy. While preparing for the birth of your baby, it’s important to stay informed about potential complications that can develop during your pregnancy. One such condition is placenta accreta. Placenta accreta is a serious medical condition where the placenta attaches too deeply to the uterine wall, making it difficult to detach during childbirth. With placenta accreta, a planned cesarean section is a medical necessity. The increasing rate of placenta accreta over the past four decades is likely due to the increased rate of cesarean delivery. In this blog, we’ll answer common questions about placenta accreta and provide you with essential information to help you navigate this aspect of your pregnancy.
The Occurance of Placenta Accreta Is Increasing
Today accreta affects as many as 1 in 272 pregnancies while studies from the 1970s and 1980s reported a rate of 1 per 2,510 to 1 per 4,017 pregnancies. The American College of Obstetrics and Gynecology and the Society forMaternal-Fetal Medicine caution,
“Placenta accreta spectrum is becoming increasingly common and is associated with significant morbidity and mortality … It is worth noting that even in the most optimal setting, substantial maternal morbidity and, occasionally, mortality occur.”
What Are the Risks Associated with Placenta Accreta?
Placenta accreta can pose serious risks to the mother/pregnant person and the baby. These risks may include:
• Bleeding during pregnancy
• Excessive bleeding during or after delivery
• A blood transfusion and a longer stay in the intensive care unit
• A hysterectomy (surgical removal of the uterus) may be necessary if the placenta cannot be safely removed or the bleeding cannot be stopped
• Preterm delivery
• Low birth weight
• A stay in a special care nursery (Neonatal Intensive Care Unit)
To minimize the risks that accompany placenta accreta physicians often recommend a planned cesarean between 34 and 36 weeks of pregnancy.
What Is the Cause of Placenta Accreta?
While the exact cause of placenta accreta is not always clear, several factors can increase the risk, including:
• Previous cesarean sections or uterine surgeries
• Advanced maternal age
• Multiple pregnancies (twins, triplets, etc.)
• A history of placenta accreta in a previous pregnancy
Placenta previa (when the placenta attaches itself very low in the uterus and can block all or part of the cervix) is another significant risk factor for placenta accreta. With no previous cesarean births placenta accreta spectrum occurs in about 3% of women diagnosed with placenta previa. However, with one or more previous cesareans, the risk for accreta is increased to 11% with two prior cesareans, 40% with three, 61% with four and 67% with five or more prior cesarean births.
What is the Placenta Accreta Spectrum (PAS)?
Placenta Accreta Spectrum refers to the different forms of accreta. The difference between placenta accreta, increta, or percreta is determined by the severity of the attachment of the placenta to the uterine wall.
Placenta Accreta occurs when the placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle and is the most common accounting for approximately 75% of all cases.
Placenta Increta occurs when the placenta attaches even deeper into the uterine wall and does penetrate the uterine muscle. Placenta increta accounts for approximately 15% of all cases.
Placenta Percreta occurs when the placenta penetrates through the entire uterine wall and attaches to another organ such as the bladder. Placenta percreta is the least common of the three conditions accounting for approximately 5% of all cases.
How Is Placenta Accreta Diagnosed?
Placenta accreta is typically diagnosed through ultrasound and other imaging techniques. Usually, placenta accreta itself has no symptoms. With a placenta previa mothers are more likely to experience bleeding during pregnancy. If the placenta begins to invade the bladder or nearby organs (placenta percreta) mothers can experience bladder or pelvic pain or may have blood in the urine.
If your physician or midwife confirms placenta accreta they are likely to refer you to a high-risk medical center with a medical team experienced with placenta accreta disorders.
How Is Placenta Accreta Managed?
Managing placenta accreta often requires a coordinated effort between obstetricians, radiologists, and other healthcare specialists.
Dealing with placenta accreta during the planned cesarean requires a highly specialized and coordinated approach due to the complexities and potential risks associated with the condition. A collaborative surgical team typically includes: an obstetrician; a maternal-fetal medicine specialist; a radiologist to help diagnose and map the extent of placenta accreta; an anesthesiologist; a urologist in case the accreta has invaded nearby organs such as the bladder; a neonatologist in case of preterm birth or other complications; and a blood bank team due to the potential for severe bleeding. The National Accreta Foundation provides guidance for how to find a hospital and surgical team with placenta accreta expertise.
What Can You Do to Reduce the Risk of Placenta Accreta?
While some risk factors are beyond your control, there is something you can do to reduce the risk of placenta accreta. The risk for placenta accreta increases with each additional cesarean section. Instead of choosing to have an elective cesarean think about planning a vaginal birth. In the United States it is difficult to find a hospital that supports a VBAC (vaginal birth after cesarean) and you are highly likely to have a second cesarean even if it is not medically indicated. If possible, avoid a routine repeat cesarean and explore the possibility of a VBAC.
Seek Support and Information
Facing the possibility of placenta accreta can be overwhelming. Reach out to your healthcare provider for guidance and support. Additionally, connect with organizations and support groups dedicated to providing information and assistance to expectant parents dealing with placenta accreta. Read about other mothers and pregnant people’s experience and recovery from placenta accreta.
Planning Ahead
As you prepare for the birth of your baby, it’s important to stay informed about potential pregnancy complications like placenta accreta. Knowledge is a powerful tool, and by understanding this condition and its risk factors, you can take steps to ensure a safe and healthy pregnancy.
This Placenta Accreta Awareness Month, let’s spread the word and ensure that expectant parents are well-informed about this condition, empowering them to make informed choices for a safe and healthy pregnancy.
Websites for Parents Seeking Information on Placenta Accreta:
References
American College of Obstetricians and Gynecologists. (2020). ACOG Practice Bulletin No. 234: Placenta Accreta Spectrum.
American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine (2018). Obstetric Care Consensus, Placenta Accreta Spectrum.
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