What is Placenta Accreta? Symptoms, Causes, & Treatment

Placenta accreta is a serious pregnancy complication where the placenta grows too deeply into the uterine wall. Instead of separating naturally after delivery, the placenta becomes firmly attached to the muscle of your uterus. This condition affects about 1 in 500 pregnancies and requires careful medical management to ensure both your safety and your baby's wellbeing.

What is Placenta Accreta?

Placenta accreta happens when the placenta implants too deeply into your uterine wall during pregnancy. Normally, the placenta attaches to the surface lining of your uterus and detaches easily after your baby is born. With placenta accreta, the placental tissue grows into the deeper muscle layer of your uterus, making separation difficult or impossible.

This condition exists on a spectrum of severity. The mildest form involves the placenta attaching to the muscle wall, while more severe forms can grow completely through the uterine wall or even into nearby organs like your bladder.

What are the Types of Placenta Accreta?

There are three main types of placenta accreta, each representing different levels of how deeply the placenta has grown into your uterine wall. Understanding these types helps your healthcare team plan the safest approach for your delivery.

• Placenta accreta (70% of cases): The placenta attaches to the uterine muscle but doesn't penetrate deeply into it
• Placenta increta (20% of cases): The placenta grows deeper into the uterine muscle wall
• Placenta percreta (10% of cases): The placenta grows completely through the uterine wall and may attach to nearby organs like the bladder or intestines

Placenta percreta is the most serious form and requires the most complex surgical planning. Your medical team will use imaging tests to determine which type you have and develop the best treatment approach.

What are the Symptoms of Placenta Accreta?

Many women with placenta accreta don't experience obvious symptoms during pregnancy. The condition is often discovered through routine ultrasound examinations or other prenatal tests. When symptoms do occur, they typically involve bleeding.

Here are the symptoms you might notice:

• Vaginal bleeding during the third trimester of pregnancy
• Bleeding that may be bright red or dark brown
• Bleeding episodes that come and go
• Abdominal pain or cramping (less common)
• Feeling unusually tired or weak

It's important to remember that third-trimester bleeding can have many causes, and placenta accreta is just one possibility. If you experience any bleeding during pregnancy, contact your healthcare provider right away for proper evaluation.

What Causes Placenta Accreta?

Placenta accreta develops when the normal barrier between the placenta and uterine muscle is damaged or missing. This usually happens because of scarring or changes to your uterine wall from previous surgeries or medical procedures.

The most common causes include:

• Previous cesarean section deliveries
• Other uterine surgeries like fibroid removal or dilation and curettage (D&C)
• Placenta previa (when the placenta covers the cervix)
• Previous uterine infections
• Multiple pregnancies
• Advanced maternal age (over 35)

Having placenta previa along with a history of cesarean sections significantly increases your risk. The combination of these factors creates an environment where the placenta is more likely to grow abnormally into scarred uterine tissue.

When to See a Doctor for Placenta Accreta?

You should contact your healthcare provider immediately if you experience any vaginal bleeding during pregnancy, especially in the third trimester. While bleeding can have many causes, it always requires medical evaluation to ensure your safety and your baby's wellbeing.

Seek immediate medical attention if you experience:

• Heavy bleeding that soaks through a pad in an hour
• Bleeding accompanied by severe abdominal pain
• Dizziness, fainting, or feeling very weak
• Rapid heartbeat or shortness of breath
• Severe cramping or contractions

Even if your bleeding seems minor, don't hesitate to call your doctor. Early detection and monitoring of placenta accreta can help prevent serious complications and ensure the best possible outcome for you and your baby.

What are the Risk Factors for Placenta Accreta?

Several factors can increase your likelihood of developing placenta accreta. Understanding these risk factors helps your healthcare team provide appropriate monitoring and care throughout your pregnancy.

The most significant risk factors include:

• Previous cesarean sections (risk increases with each C-section)
• Placenta previa in your current pregnancy
• Advanced maternal age (35 years or older)
• Multiple previous pregnancies
• Previous uterine surgeries or procedures
• History of uterine infections
• Previous dilation and curettage (D&C) procedures
• Asherman's syndrome (uterine scarring)

Having one or more risk factors doesn't mean you'll definitely develop placenta accreta. However, your healthcare provider may recommend additional monitoring with ultrasounds or MRI scans to watch for signs of the condition.

What are the Possible Complications of Placenta Accreta?

Placenta accreta can lead to serious complications, primarily related to severe bleeding during delivery. Understanding these potential complications helps you and your healthcare team prepare for the safest possible delivery.

The main complications include:

• Severe hemorrhage during delivery requiring blood transfusion
• Need for emergency hysterectomy (removal of the uterus)
• Damage to nearby organs like the bladder or intestines
• Blood clotting problems
• Infection
• Preterm delivery
• Need for intensive care unit (ICU) admission

While these complications sound frightening, remember that with proper planning and care from an experienced medical team, most women with placenta accreta have successful outcomes. Early diagnosis allows your healthcare providers to assemble the right specialists and prepare for any challenges that might arise.

How is Placenta Accreta Diagnosed?

Placenta accreta is typically diagnosed through imaging tests during pregnancy. Your healthcare provider will use ultrasound as the first step, often followed by MRI for more detailed information about the extent of the condition.

The diagnostic process usually involves:

• Detailed ultrasound examination by a maternal-fetal medicine specialist
• MRI scan to better visualize the placenta and surrounding tissues
• Review of your medical history and risk factors
• Sometimes additional specialized imaging tests

These tests help your medical team determine the type and severity of placenta accreta. This information is crucial for planning your delivery and ensuring the right specialists are available when you give birth.

What is the Treatment for Placenta Accreta?

Treatment for placenta accreta focuses on timing your delivery carefully and having the right medical team in place. The main treatment approach is planned cesarean section with possible hysterectomy, depending on the severity of your condition.

Your treatment plan will typically include:

• Scheduled cesarean delivery between 34-36 weeks of pregnancy
• Multidisciplinary team including maternal-fetal medicine specialists, anesthesiologists, and blood bank specialists
• Preparation for possible hysterectomy if bleeding cannot be controlled
• Blood products available for transfusion if needed
• Possible placement of temporary balloon catheters to control bleeding

In some cases, your medical team might try to preserve your uterus using specialized techniques. However, if bleeding is severe, hysterectomy may be necessary to save your life. Your healthcare team will discuss all options with you well before delivery.

How to Take Care of Yourself During Pregnancy with Placenta Accreta?

If you've been diagnosed with placenta accreta, taking good care of yourself becomes even more important. Your healthcare team will provide specific guidelines, but there are general steps you can take to support your health and your baby's development.

Here's how you can care for yourself:

• Attend all prenatal appointments and follow your provider's recommendations
• Take prenatal vitamins, especially iron if recommended
• Rest when you feel tired and avoid strenuous activities
• Stay hydrated and eat a nutritious diet
• Monitor for any signs of bleeding or unusual symptoms
• Have a plan for getting to the hospital quickly if needed

Your healthcare provider may recommend modified activity levels or bed rest depending on your specific situation. Following these recommendations helps reduce your risk of complications and supports the best possible outcome for you and your baby.

How Should You Prepare for Your Doctor Appointments?

Being well-prepared for your appointments helps ensure you get the most benefit from your time with your healthcare team. Having placenta accreta means you'll likely have more frequent visits and may see multiple specialists.

Here's how to prepare for your appointments:

• Write down all your questions before the visit
• Bring a list of all medications and supplements you're taking
• Keep a record of any symptoms, bleeding episodes, or concerns
• Bring a support person if possible
• Ask for written instructions or information to take home
• Understand your delivery plan and what to expect

Don't hesitate to ask your healthcare team to explain anything you don't understand. Understanding your condition and treatment plan helps you feel more confident and prepared for what lies ahead.

What's the Key Takeaway About Placenta Accreta?

Placenta accreta is a serious but manageable pregnancy complication when diagnosed early and treated by an experienced medical team. While it can sound overwhelming, remember that thousands of women successfully navigate this condition each year with proper care and planning.

The most important thing is working closely with your healthcare team to develop a comprehensive plan for your delivery. With early diagnosis, careful monitoring, and skilled medical care, most women with placenta accreta have positive outcomes.

Trust in your medical team's expertise and don't hesitate to ask questions or voice concerns. Your active participation in your care, combined with skilled medical management, gives you the best chance for a safe delivery and healthy recovery.