17846 Placenta Accreta

Overview

Placenta accreta is a serious pregnancy condition where the placenta (the organ that gives your baby oxygen and nutrients) attaches too deeply to the wall of the womb (uterus) and does not break away easily after birth. It can lead to heavy bleeding and needs careful medical planning.

Placenta accreta is rare, but the number of cases has risen in recent years, particularly due to more cesarean deliveries.

It affects pregnant women, especially those who have had a cesarean section before, have a low-lying placenta (placenta previa), or have had uterine surgery.

Symptoms

Common symptoms

• Often there are no symptoms, and it is found on ultrasound. Some women may notice light vaginal bleeding during pregnancy.

Symptoms in children

• Not applicable – this condition affects pregnancies, not children directly.

Symptoms in older adults

• Not applicable – this condition occurs during pregnancy, not in older age.

Causes

Main causes

• The exact cause is not known, but it happens when the placenta grows into the muscle layer of the womb, usually because of a scar from previous surgery.

Risk factors

• Previous cesarean delivery
• Previous surgery on the womb, such as fibroid removal
• Placenta previa
• Being older than 35
• Having had several pregnancies

When to see a doctor

See a doctor urgently if:

• If you have any vaginal bleeding in pregnancy, especially after the second trimester
• If you have strong pains or contractions before your due date
• If your baby is moving less than usual

Book a routine appointment if:

• At your regular prenatal check-ups, share any concerns about your pregnancy. Your doctor will arrange extra scans if you have risk factors.

Diagnosis

Placenta accreta is usually seen on a routine ultrasound scan around 20 weeks. If the ultrasound is unclear, an MRI (magnetic resonance imaging) scan might be used to get a clearer picture.

Tests that may be done

• Ultrasound scan
• MRI (magnetic resonance imaging) scan

What to expect at your appointment

If you are diagnosed, you will be referred to a multidisciplinary team (obstetricians, anesthetists, and specialist midwives) at a hospital that handles high-risk pregnancies. You will have regular follow-up scans and a clear plan for your baby's birth.

Treatment

The main treatment is a carefully planned delivery. This almost always involves a cesarean section. Depending on your situation, the placenta may be left to come away on its own, or it may be removed surgically. In severe cases, the womb may need to be removed (hysterectomy) to stop life-threatening bleeding.

Self-care at home

• Go to all your prenatal appointments and scans
• Follow your care plan and keep your hospital team informed of any symptoms
• Plan ahead with your team about your preferred hospital for delivery

Medical treatments

Your healthcare team may give you medication to help your womb contract and to lower the risk of heavy bleeding. In some cases, a procedure called uterine artery embolization may be used to reduce blood flow to the placenta. Always discuss your options with your doctor.

When is surgery considered?

Surgery is planned, usually at around 34-36 weeks of pregnancy. This is to balance the risk of early delivery with the risk of heavy bleeding. In an emergency, surgery may be done earlier. Some women will need a hysterectomy, which means the womb is removed, and this ends the ability to become pregnant in the future. The decision is discussed with you in advance whenever possible.

Living with this condition

After you are diagnosed, you will need extra rest and should avoid heavy lifting. You may be advised to stop working and stay close to the hospital from a certain point in your pregnancy. Your care team will give you specific advice.

Lifestyle tips

• Reduce stress by doing gentle activities like walking, as approved by your doctor
• Avoid lifting heavy objects or doing strenuous exercise
• Have a support system at home, and accept help from family and friends

Diet and exercise

Eat a balanced diet with plenty of fruits and vegetables, and drink plenty of water. Light exercise such as walking or prenatal yoga is usually safe, but always check with your doctor first.

Mental health and emotional wellbeing

A high-risk pregnancy can feel scary and overwhelming. It is normal to feel anxious. Talk to your partner, family, or a counsellor. Your midwife can also provide emotional support.

Prevention

Placenta accreta cannot always be prevented, but it may be possible to lower the risk by planning pregnancies and discussing any uterine surgery with your doctor. If you have had a cesarean, waiting a certain time before your next pregnancy may be helpful. Always talk with your healthcare provider about your personal risks.

Screening programmes

Routine ultrasound scans in pregnancy can catch placenta accreta early, so attend all your appointments.

Complications

If left untreated

• Severe, life-threatening bleeding after birth
• Need for blood transfusions
• Damage to the womb or other organs
• In very rare cases, the need for an emergency hysterectomy

Long-term outlook

With careful planning and a specialist hospital team, most women do very well. The condition is serious, but it is now managed proactively. Many women go on to recover and care for their baby. Some may face emotional or physical changes, but support is available.

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