October has been established as Accreta Awareness Month to raise awareness about this potentially life-threatening condition that can occur during pregnancy.
Patients with accreta have their placenta attach too deeply so it cannot be expelled during childbirth, putting them at risk of severe bleeding.
Fortunately, with expert care from a high-risk obstetrics specialist, new moms typically have a successful delivery and recovery.
For most expectant moms, the placenta nourishes their baby during pregnancy and is then safely expelled during childbirth.
But some women face a condition where the placenta attaches so deeply it cannot detach, putting the mother at risk of life-threatening hemorrhage. These disorders are part of the Placenta Accreta Spectrum, and there are three levels of severity:
- Placenta Accreta, where the placenta grows into the uterine wall
- Placenta Increta, where the placenta attaches to the uterine muscle
- Placenta Percreta, where the placenta invades another organ
Molly Houser, MD leads Regional One Health’s Complex Obstetric Surgery Program, part of our Center of Excellence in High-Risk Obstetrics. She explained why the condition is so serious: “If the placenta doesn’t deliver, it can cause life-threatening bleeding. Many patients require an emergency hysterectomy, which can be very dangerous at the time of delivery.”
Placenta Accreta Spectrum disorders, formerly known as morbidly adherent placenta or invasive placentation, are becoming more common, with about 1 in 272 pregnant women affected.
Some women discover the condition during pregnancy, usually in their second or third trimester, based on their ultrasounds. However, imaging is only successful in detecting placenta accreta spectrum about 80-90% of the time, Dr. Houser said.
While women often don’t experience symptoms, there are identified risk factors:
- History of cesarean delivery
- History of uterine abnormalities, such as fibroids or scarring
- Placenta previa, where the placenta is low in the uterus and covers the cervix
- Advanced maternal age
- Prior uterine surgery
The only way to reach a conclusive diagnosis is to examine a patient when their abdomen is opened for a C-section, Dr. Houser said – and at that point, the patient’s life may already be at risk. Placenta Accreta Spectrum disorders are so dangerous that doctors in small hospitals who encounter the condition during a C-section are advised to take a photograph, close the patient’s abdomen and send them to a larger hospital with resources to care for a significant hemorrhage.
It highlights how important specialized care is to good outcomes, Dr. Houser said. Patients need to be treated at a hospital that has the technology and expertise to manage the condition safely.
She said if Placenta Accreta Spectrum is suspected or diagnosed during pregnancy, the patient should be closely monitored by a high-risk pregnancy specialist. Patients will also be scheduled for a C-section, usually between 34 weeks and 35 weeks, 6 days of pregnancy.
Patients may be hospitalized during pregnancy due to bleeding, contractions, or because they live a long way from the specialized care they need and would be put at risk by going into labor at home.
The specialized level of care continues during and after the C-section.
At Regional One Health, Dr. Houser leads a multidisciplinary team that is mobilized whenever a Placenta Accreta Spectrum patient delivers.
The team includes specialists from maternal fetal medicine, obstetrics, labor and delivery, gynecologic oncology, trauma surgery, anesthesia, interventional radiology, urology, critical care, pathology, blood bank and neonatology. Regional One Health also has an onsite blood bank, which is crucial for patients who end up needing a transfusion.
Having all of those resources in place gives patients their best chance of a successful delivery and recovery, Dr. Houser said. While many patients will need a hysterectomy, she said, in some cases physicians can perform surgeries that avoid hysterectomy and preserve fertility.
She is proud of the team Regional One Health has in place to care for Placenta Accreta Spectrum patients and other high-risk pregnancy conditions.
“Everyone works together to provide the care our patients need,” Dr. Houser said. “It highlights our team’s expertise in providing care for patients with complex medical and surgical conditions.”