What is placenta accreta? It's a rare condition that affects around 0.2% of pregnancies. Normally, your placenta forms an attachment to the uterine lining — the endometrium. But with accreta, it goes even further and attaches to your uterine wall.
What Is the Placenta?
The placenta is a tissue that acts as an intermediary between you and your baby. It provides your growing baby with blood, oxygen, and nutrients and removes waste products. Normally, the tissue detaches from the endometrium after you’ve given birth and comes out in the afterbirth.
What Is the Placenta Accreta Spectrum?
Placenta accreta falls within a spectrum of three closely related conditions. The main distinguishing feature is how extensively your placenta is attached.
The three degrees of placental attachment are:
- Placenta accreta. This is the mildest form of attachment, in which the placenta has attached to the uterine wall.
- Placenta increta. This is an intermediate form of attachment in which the placenta becomes deeply attached to the uterine muscle wall.
- Placenta percreta. This is the most severe form of attachment. In this case, the placenta grows beyond the uterus and into nearby organs like your bladder.
Placenta Accreta Causes
Cases of placenta accreta are on the rise. In the 1960s, the rate was only about 1 in 30,000 pregnancies. In the 2000s, the rates have increased to at least 1 in every 533 pregnancies.
The main reason for this rise is because of the increased rates of Cesarean sections (C-sections). This procedure causes scarring to your uterus. This, in turn, makes it more difficult for the placenta to attach in later pregnancies.
The more C-sections you’ve had, the greater risk you face. If you've had only one C-section, your risk is 0.3%. There's a 6.7% chance if you’ve had five or more.
Any other procedures that cause scarring on or near your uterus increase your risk as well. Examples of these surgeries include:
Other risk factors for developing placenta accreta include:
- Being 35 or older
- Placenta previa — a condition where your placenta partially or completely blocks your cervix. This is seen in 80% of accreta cases.
- Previous childbirth — the more children you’ve had, the greater your risk
- Asherman Syndrome — a condition where scar tissue forms in your uterus, mainly from uterine surgical procedures
Placenta Accreta Diagnosis
Placenta accreta is usually diagnosed with an ultrasound. This can happen during a routine appointment. Your doctor may also specifically check for the condition if you fall into a high-risk category. Sometimes your doctor will also need to do magnetic resonance imaging (MRI) to distinguish between placenta accreta vs. increta vs. percreta.
Ideally, your medical team will know how deeply your placenta is attached so they can decide on the best plan for your delivery. But imaging this attachment is difficult and identifying the extent isn’t always possible.
Placenta Accreta Symptoms
You likely won’t have any symptoms of placenta accreta. In cases of more severe attachment — like placenta percreta — you might feel pain in your pelvic area or see blood in your urine.
Placenta Accreta Complications
The biggest problem caused by placenta accreta comes when you’re delivering your baby. If you have placenta accreta, your placenta won’t detach like it's supposed to and come out in the afterbirth. This can cause problems for both you and your baby.
Complications for your baby include:
- The need to schedule the birth 3–6 weeks early, depending on the severity of the accreta and whether or not you also have previa
- An increased risk of needing the newborn intensive care unit (NICU) due to premature birth
- Instability from heavy bleeding, which could result in an even more premature — and possibly unscheduled — delivery
The main complications from this condition are those that you'll face yourself. They include:
- Hemorrhaging. This extreme heavy bleeding can be life-threatening if not properly treated.
- Problems with vaginal birth. You may not be able to give birth vaginally. And if you do, you may need specialized follow-up procedures to remove the placenta to avoid losing too much blood.
- The need for ahysterectomy. This may be the only way to remove your placenta.
Placenta Accreta Treatment
The exact treatment for your condition will depend on how firmly your placenta is attached. You usually won’t have to do anything special before you give birth, but you should plan on having your baby in a hospital. This will allow your medical team to provide any emergency medical treatment that you or your baby might need — particularly emergency blood transfusions if you start to lose too much blood.
In most cases, you’ll need to have a combination C-section and hysterectomy — called a Cesarean hysterectomy. This removes your entire uterus along with your placenta. Afterward, you won’t be able to have more children.
In a hysterectomy, your uterus is removed. Sometimes your ovaries are as well. In cases of placenta accreta, your ovaries will be left in place to prevent premature menopause.
If you want to have more children, your doctor might try to only remove parts of your placenta, leaving some of it attached to your uterus. There’s a chance that your placenta will dissolve and be reabsorbed into your body over time.
But if you don’t heal properly, you’ll still need to have a hysterectomy at a later date. You’ll also run the risk of infection from the remaining parts of your placenta.
The most dangerous scenario would be having a vaginal birth without realizing that you have placenta accreta. In this case, you’d need immediate emergency attention in order to deal with the life-threatening amounts of blood that you may lose. Your medical team will need to determine the best treatment method as the emergency is happening.
Placenta Accreta Recovery
Your post-birth recovery with placenta accreta might be somewhat different than if you had a standard delivery. You may need to stay in the intensive care unit (ICU) for a day or two to help you recover from extreme blood loss.
Your total hospital stay is likely to be between 3 and 5 days — which is typical for a C-section. You’ll receive pain medication throughout this time and be sent home with a prescription. If the delivery was particularly difficult, you may need frequent check-ups to monitor your health and recovery as well as the health of your baby.
Each pregnancy is different, so make sure that you and your doctor decide on a birth and treatment plan that’s best for you.