Placenta Accreta

Placenta Accreta is a potentially life-threatening pregnancy complication that occurs when the placenta grows too deeply into the uterine wall. In this article, we will discuss the causes, symptoms, diagnosis, and treatment options for placenta accreta.

What is Placenta Accreta?

During pregnancy, the placenta is responsible for delivering oxygen and nutrients to the developing fetus. Placenta accreta is a condition where the placenta becomes too deeply embedded in the uterine wall, making it difficult to detach the placenta from the uterus after childbirth.

There are three types of placenta accreta:

1.) Placenta accreta

2.) Placenta increta

3.) Placenta percreta

Placenta accreta occurs when the placenta grows too deeply into the uterine wall, but it does not penetrate through the uterine muscle. This can cause complications during delivery, such as heavy bleeding, but is usually less severe than other types of placenta abnormalities.

Placenta increta occurs when the placenta grows deeply into the uterine muscle, making it more difficult to remove during delivery. This can increase the risk of heavy bleeding, infection, and the need for a hysterectomy.

Placenta percreta occurs when the placenta grows through the uterine wall and into other organs, such as the bladder or bowel. This is the most severe form of placenta abnormality, and can cause life-threatening complications, such as severe bleeding and organ damage. Treatment for placenta percreta often requires a team approach, with specialists from obstetrics, gynecology, and other medical fields working together to manage the condition.

What Causes Placenta Accreta?

Placenta accreta is caused by a problem with the placenta's attachment to the uterus. In a healthy pregnancy, the placenta detaches from the uterine wall after the baby is born. However, in placenta accreta, the placenta grows too deeply into the uterine wall, making it difficult to detach.

The exact cause of placenta accreta is not entirely understood, but several risk factors have been identified.

One of the main risk factors for placenta accreta is a previous cesarean delivery. Women who have had a prior cesarean delivery have a higher risk of developing placenta accreta because the scar tissue from the previous surgery can interfere with the implantation of the placenta in subsequent pregnancies.

Other risk factors for placenta accreta include placenta previa (a condition in which the placenta covers the cervix), multiple pregnancies (such as twins or triplets), advanced maternal age, a history of uterine surgery, and certain medical conditions such as endometriosis and Asherman's syndrome (a condition in which scar tissue forms inside the uterus).

Placenta accreta can also occur in women who have never been pregnant, although this is rare. In these cases, the condition is usually associated with a molar pregnancy, a type of abnormal pregnancy in which a tumor develops instead of a normal fetus.

Overall, the exact cause of placenta accreta is not entirely clear, but it is believed to be related to problems with the formation and development of the placenta. More research is needed to better understand the underlying mechanisms and risk factors for this condition.

Features of Placenta Accreta

Placenta accreta may not have any symptoms during pregnancy. However, some women may experience the following:

1.) Vaginal bleeding: Women with placenta accreta may experience vaginal bleeding during the third trimester of pregnancy. The bleeding may be heavy or light, and it may be accompanied by cramping or abdominal pain.

2.) Abnormal fetal position: The baby may be in a breech position, which means that the baby's feet or buttocks are positioned to come out first during delivery. This is because the placenta may be blocking the baby's head from descending into the pelvis.

3.) Preterm labor: Women with placenta accreta may experience preterm labor, which means that labor starts before 37 weeks of pregnancy. Preterm labor can lead to premature birth, which can increase the risk of complications for both the mother and the baby.

It's important to note that these symptoms can be caused by other conditions as well, so if you experience any of these symptoms, it's essential to contact your healthcare provider immediately for evaluation and treatment.

Complications of Placenta Accreta

Placenta accreta can lead to a range of complications for both the mother and the fetus. Some of the most common complications associated with placenta accreta include:

Excessive Bleeding

Placenta accreta can cause excessive bleeding during delivery, which can be life-threatening for the mother.

Preterm Delivery

Placenta accreta may increase the risk of preterm delivery, which can lead to a range of complications for the fetus.

Cesarean Delivery

Placenta accreta often requires a cesarean delivery, which can increase the risk of complications such as infection, bleeding, and blood clots.

Hysterectomy

In severe cases of placenta accreta, a hysterectomy may be necessary to control bleeding and prevent further complications.

Maternal Morbidity

Placenta accreta can increase the risk of maternal morbidity, including infection, hemorrhage, and damage to surrounding organs.

Fetal Distress

Placenta accreta can put stress on the fetus, leading to fetal distress and an increased risk of stillbirth.

Neonatal Intensive Care

Babies born to mothers with placenta accreta may require neonatal intensive care due to complications such as premature birth, low birth weight, or other medical issues.

Long-Term Effects

In some cases, placenta accreta can have long-term effects on the mother's health, such as chronic pelvic pain, infertility, or bladder or bowel problems.

Early detection and appropriate management of placenta accreta can help reduce the risk of complications and improve maternal and fetal outcomes.

Diagnosis of Placenta Accreta

Placenta accreta can be diagnosed through various imaging tests, including ultrasound, MRI (magnetic resonance imaging), and CT (computed tomography) scans. These tests are typically performed during the second or third trimester of pregnancy.

Ultrasound: This is usually the first imaging test used to diagnose placenta accreta. It is a non-invasive procedure that uses high-frequency sound waves to create images of the uterus and placenta. An ultrasound can show if the placenta is attached too deeply into the uterine wall or if there are any signs of abnormal blood flow.

MRI: If the results of the ultrasound are inconclusive, an MRI may be recommended. An MRI uses a powerful magnet and radio waves to create detailed images of the body's internal structures. It can provide more detailed information about the placenta's location and the extent of the invasion into the uterine wall.

In addition to these diagnostic tools, doctors may also use a range of clinical assessments to identify placenta accreta. This may include regular monitoring of maternal blood pressure and the fetal heart rate, as well as regular ultrasounds to check for signs of placental invasion or abnormalities.

It's important to note that while imaging tests can be helpful in diagnosing placenta accreta, they are not 100% accurate. In some cases, a diagnosis may only be confirmed during delivery, and the severity of the condition may not be fully known until after the birth of the baby. That's why it's essential for women who have risk factors for placenta accreta to receive close monitoring and care during pregnancy.

Management of Placenta Accreta

Management for placenta accreta typically involves a multidisciplinary approach, with a team of specialists working together to develop a plan that meets the individual needs of the mother and fetus. The specific management plan will depend on the severity of the condition, the gestational age of the fetus, and the overall health of the mother. 

The management strategies for placenta accreta include:

A.) Antenatal care

Early detection of placenta accreta is key to effective management. Women who are at increased risk of placenta accreta, such as those with a history of cesarean delivery or placenta previa, should receive regular antenatal care and monitoring.

B.) Delivery planning

In cases where placenta accreta is suspected or diagnosed, delivery should be planned in a tertiary care center with access to a level III neonatal intensive care unit and a blood bank capable of providing massive transfusions. A team of specialists including obstetricians, anesthesiologists, hematologists, and neonatologists should be involved in the management of the delivery. In most cases, a scheduled cesarean delivery is recommended to minimize the risk of bleeding and other complications.

C.) Management During Delivery

One important consideration in the management of placenta accreta during delivery is the timing and mode of delivery. In most cases, a planned cesarean delivery is recommended to avoid the risk of spontaneous rupture of the uterus during labor. The delivery should be performed at a gestational age that balances the risk of preterm delivery with the risk of placental invasion and hemorrhage. In some cases, delivery may need to be scheduled earlier than 34 weeks if there is evidence of placental invasion and fetal compromise.

During the delivery, the focus should be on minimizing blood loss and ensuring the safety of the mother and baby. 

1.) Cesarean Hysterectomy: A cesarean hysterectomy may be necessary in cases of severe placental invasion or hemorrhage that cannot be controlled with conservative measures. In cases where a hysterectomy is necessary, women may experience emotional and psychological challenges related to the loss of fertility. Counseling and support may be necessary to help women cope with these challenges and make informed decisions about their future reproductive options.

2.) Uterine Preservation Techniques: In cases where the mother wishes to preserve her uterus for future pregnancies, uterine preservation techniques such as uterine artery embolization or balloon tamponade may be used to control bleeding and prevent the need for a hysterectomy.

3.) Medical Interventions: In addition to surgical management, pharmacological interventions may also be necessary to manage bleeding and prevent complications. Medications such as oxytocin, carboprost, and misoprostol may be used to control bleeding and promote uterine contraction. Close monitoring of vital signs, fluid and electrolyte balance, and coagulation status is essential during the delivery and postpartum period.

D.) Postpartum Care

Postpartum management of placenta accreta can be complex and require close monitoring to ensure that the mother receives the appropriate treatment to prevent further complications. 

1.) Supportive Care: One of the main concerns is the risk of excessive bleeding, which may require blood transfusions to replace lost blood volume. Additionally, medications may be given to control bleeding, such as uterotonics or hemostatic agents.

2.) Surgical management: If the placenta was not removed during delivery, a surgical procedure called curettage may be necessary to remove any remaining placental tissue. In severe cases of placenta accreta, a hysterectomy may be necessary to remove the uterus and stop bleeding.

3.) Monitoring: Close monitoring for complications is also important, as the risk of infection and blood clots is increased in women with placenta accreta. Antibiotics may be given to prevent or treat infection, and measures such as early mobilization and compression stockings may be used to prevent blood clots.

Neonatal care

Babies born to mothers with placenta accreta may require specialized neonatal care, such as monitoring for prematurity or low birth weight, or treatment for other medical issues.

Follow-up care

Women who have had placenta accreta should receive follow-up care to monitor for any long-term effects or complications, such as chronic pelvic pain, bladder or bowel problems, or infertility.

Overall, prompt and appropriate management of placenta accreta is crucial for reducing the risk of serious complications and ensuring the best possible outcome for the mother and baby.

Prognosis of Placenta Accreta

The prognosis for placenta accreta depends on several factors, including the severity of the condition, the timing of diagnosis, and the effectiveness of management strategies.

Placenta accreta can be a life-threatening condition, with the potential for severe bleeding during delivery and other complications. However, with proper management and timely intervention, the prognosis for both the mother and baby can be good.

Women with placenta accreta are at increased risk for complications during delivery, including heavy bleeding, infection, and the need for a hysterectomy. They may also experience long-term complications, such as chronic pelvic pain, infertility, or bladder or bowel problems.

Babies born to mothers with placenta accreta may be at increased risk for premature birth, low birth weight, and other medical issues. However, with appropriate neonatal care, many of these babies go on to lead healthy, normal lives.

Summary

In conclusion, placenta accreta is a serious condition that requires prompt medical attention. Women who have had previous uterine surgery or other risk factors should be aware of the symptoms and seek medical help if they suspect placenta accreta. With proper care and treatment, most women with placenta accreta can deliver healthy babies and recover fully from the condition.