Placenta Accreta

Placenta accreta is a rare but serious pregnancy complication that occurs when the placenta grows too deeply into the uterine wall. The placenta is a vital organ that develops in the uterus during pregnancy, providing oxygen and nutrients to the fetus and removing waste products.

Types of Placenta Accreta

There are three types of placenta accreta, which vary in severity:

• Placenta accreta: The placenta grows into the uterine lining but does not penetrate the muscle layer.
• Placenta increta: The placenta grows into the muscle layer of the uterus.
• Placenta percreta: The placenta grows through the entire uterine wall and may attach to other organs, such as the bladder or intestines.

Causes and Risk Factors

The exact cause of placenta accreta is not known, but several factors increase the risk:

• Previous uterine surgery, such as a cesarean section or dilation and curettage (D&C)
• Placenta previa (a condition where the placenta covers the cervix)
• Multiple pregnancies
• Advanced maternal age
• Prior uterine scars or adhesions

Symptoms

Symptoms of placenta accreta may include:

• Vaginal bleeding during the second or third trimester
• Painful vaginal bleeding
• Severe abdominal pain
• Fetal distress

Diagnosis

Placenta accreta is typically diagnosed using:

• Ultrasound imaging
• Magnetic resonance imaging (MRI)
• Pelvic exam

A definitive diagnosis may not be made until after delivery, when the placenta can be examined.

Treatment and Management

Treatment for placenta accreta depends on the severity of the condition and the stage of pregnancy:

• Expectant management: Close monitoring of the mother and fetus, with possible hospitalization to manage bleeding and prevent complications.
• Pregnancy termination: In severe cases, delivery may be necessary to prevent further complications.
• Hysterectomy: Surgical removal of the uterus may be required in some cases to control bleeding and prevent further complications.

Complications

Placenta accreta can lead to serious complications, including:

• Severe bleeding (hemorrhage)
• Shock
• Organ failure
• Premature birth
• Fetal distress or death

Prevention

While there is no guaranteed way to prevent placenta accreta, reducing the risk of uterine scarring and adhesions through:

• Avoiding unnecessary uterine surgery
• Minimizing the number of cesarean sections
• Optimizing prenatal care to detect potential complications early

may help reduce the risk of developing placenta accreta.

Frequently Asked Questions (FAQs)

What is placenta accreta?
A condition where the placenta abnormally attaches to the uterus.

What are the symptoms of placenta accreta?
Typically asymptomatic, but may cause vaginal bleeding during pregnancy.

What causes placenta accreta?
Likely due to scarring in the uterus, often from prior uterine surgery.

How is placenta accreta diagnosed?
Usually through ultrasound and MRI imaging.

Can placenta accreta be prevented?
Possibly by avoiding multiple uterine surgeries, but not definitively proven.

What are the risks associated with placenta accreta?
Severe bleeding, preterm birth, and maternal morbidity.

How is placenta accreta typically managed?
Often requires a planned cesarean delivery and possible hysterectomy.

Can women with placenta accreta have a vaginal delivery?
Generally not recommended due to high risk of severe bleeding.

What is the recurrence risk for placenta accreta?
Possibly higher in subsequent pregnancies, but exact risk unclear.

Is placenta accreta related to other pregnancy complications?
May be associated with placenta previa and other placental abnormalities.