Placenta Accreta

Placenta accreta is a severe obstetric complication that occurs in about 1 out of every 2,500 pregnancies. In these pregnancies, there is an abnormal superficial attachment of the placenta to the middle layer of the uterus (clinically referred to as the myometrium). This attachment greatly increases the risk of hemorrhage during delivery. The incidence of placenta accreta is on the rise, and the likely link is believed to be the increased number of cesarean sections.

Risk factors for placenta accreta include; placenta previa, previous cesarean delivery, Asherman’s syndrome, and maternal ages of thirty-six or older. Most often, this condition is not known until delivery occurs. When the condition is suspected, ultrasounds, MRI’s or color Doppler studies can help confirm diagnosis. If there is strong suspicion or confirmed diagnosis before delivery, ACOG recommends that patients be informed of the high likelihood of a hysterectomy and/or need for blood transfusion. Patients should also be counseled regarding the need to select the safest location and timing for the delivery. It is important that the patient understands the need for there to be access to a surgical team during her delivery.

When diagnoses of placenta accreta is highly suspected or made before delivery, a planned cesarean section should be planned at 36-37 weeks. Before delivery, fetal lung maturity should be assessed and documented. Otherwise delivery should occur at any of the following criteria; 38 weeks, with bleeding, and/or spontaneous labor. Mortality rates for women with this condition can be as high as 10%. Abdominal hysterectomies are common consequences of this obstetrical complication because this problem mostly manifests itself during the delivery of the placenta which occurs after the delivery of the infant. There is often no effect of this condition on the fetus.

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