What is Placenta Accreta?
Placenta accreta is a serious pregnancy condition in which the placenta grows too deeply into the wall of the uterus and does not detach properly after childbirth. Normally, the placenta separates from the uterine wall after delivery, but in placenta accreta, part or all of it remains attached, which can lead to severe bleeding and complications during or after delivery.
There are different forms of the condition:
- Placenta accreta: Placenta attaches too deeply into the uterine wall but does not penetrate the muscle.
- Placenta increta: The placenta invades into the uterine muscle.
- Placenta percreta: The placenta grows through the uterine wall and may attach to nearby organs such as the bladder.
What Causes Placenta Accreta?
The exact cause is unclear, but several risk factors increase the likelihood, including:
- Previous cesarean section (C-section)
- Placenta previa (placenta covering the cervix)
- Previous uterine surgery (e.g., myomectomy or D&C)
- Maternal age over 35
- Multiple pregnancies
- Uterine scarring
What Are the Symptoms of Placenta Accreta?
Placenta accreta may not cause noticeable symptoms during pregnancy. However, warning signs can include:
- Vaginal bleeding in the third trimester (especially with placenta previa)
- Abnormal findings on routine ultrasound
- Difficulty in delivering the placenta after childbirth
- Severe bleeding (hemorrhage) during delivery
Most cases are detected through prenatal imaging rather than symptoms.
How Is Placenta Accreta Diagnosed?
Diagnosis usually involves:
- Ultrasound: Often the first tool used to assess placental attachment
- MRI: Provides detailed images to evaluate how deeply the placenta has invaded the uterus or surrounding structures
- Medical history review: Especially important in women with prior uterine surgeries or cesarean deliveries
Early diagnosis allows better planning for a safer delivery.
What Are the Treatment Options for Placenta Accreta?
Management depends on the severity and timing of the diagnosis:
- Planned cesarean hysterectomy: The most common and safest option, where the baby is delivered by C-section, followed by removal of the uterus with the placenta still attached to prevent massive bleeding
- Conservative management (in selected cases): May involve leaving the placenta in place and monitoring, but this carries risks of infection and delayed bleeding
- Blood transfusions and intensive care: Often needed due to blood loss during delivery
Delivery is usually planned around 34–36 weeks of pregnancy to minimize risks.
What Is the Prognosis for Placenta Accreta?
The prognosis can be good with early diagnosis and careful planning, but the condition carries risks:
- High risk of severe bleeding (postpartum hemorrhage)
- Increased need for hysterectomy
- Risk to the mother’s life if not properly managed
- Possible preterm birth for the baby due to early delivery
With specialized care and preparation, most mothers and babies do well.
How Can Placenta Accreta Be Managed Long-Term?
- Women with placenta accreta usually cannot have future pregnancies if the uterus is removed.
- Emotional and psychological support is important due to the unexpected nature of complications and potential fertility loss.
- Post-surgical follow-up is essential to ensure recovery and manage any complications.
When Should I See a Doctor?
Seek medical care if you:
- Have a history of cesarean or uterine surgery and are planning a pregnancy
- Experience vaginal bleeding during pregnancy
- Have been diagnosed with placenta previa
- Want to discuss birth planning if placenta accreta is suspected or confirmed