We all know that your baby in the womb gets all the nutrition and oxygen it needs from the placenta. After the baby is born, this placenta usually comes out of the uterus easily within a few minutes. That is the normal process. But imagine, what happens if this placenta gets stuck a little deeper and more tightly to the uterine wall than you think? If that happens, it will not come off easily after the baby is born. That is the serious medical condition we call Placenta Accreta . Although this is a serious condition, if it is recognized early and managed correctly , it can protect both the mother and the baby. So, let's talk about this in detail without any fear.
What is Placenta Accreta simply?
Simply put, Placenta Accreta is when the placenta attaches too deeply to the wall of the uterus. In a normal pregnancy, the placenta attaches only to the inner lining of the uterus (endometrium). Therefore, it is easily separated after the baby is born.
But in the case of Placenta Accreta, parts of the placenta may have grown into the muscle layer of the uterus. Therefore, when the placenta is removed after the baby is born, it may not come off and start bleeding profusely . This is the biggest and most dangerous complication here. Sometimes this bleeding can even be life-threatening. Therefore, a mother with this condition may have to undergo a blood transfusion or, in the most severe cases, even have a hysterectomy.
Are there different types of this?
Yes, it is divided into three main types depending on the depth at which the placenta attaches to the uterine wall. This classification is very important for planning treatment.
| Status name (Type) | Simply description |
|---|---|
| Placenta Accreta | This is the most common type. Here, the placenta is firmly attached to the uterine wall, but has not penetrated the muscular layer of the uterus. |
| Placenta increta | Here, the placenta has grown into the muscular layer of the uterine wall (myometrium). This is a little more serious. This condition occurs in about 15% of cases. |
| Placenta Percreta | This is the most severe and dangerous type. Here, the placenta completely penetrates the uterine wall and may even attach to nearby organs such as the bladder or intestines. This occurs in only a very small number of people, about 5%. |
Who is at higher risk of developing this condition?
Although Placenta Accreta can occur in any pregnant woman, there are certain factors that increase the risk. It is important to talk to your doctor about these things.
- Previous cesarean section (C-section): This is the main risk factor. A C-section makes an incision in the uterus. As it heals, scar tissue forms. If the placenta implants in this scar during a subsequent pregnancy, it is more likely to attach deeper than normal tissue. The more C-sections you have, the higher your risk of Placenta Accreta.
- Placenta Previa: Some pregnant women have a placenta that is located in the lower part of the uterus, covering the cervix. This is called ``Placenta Previa.`` If you have had a previous C-section and also have this ``Placenta Previa`` condition, the risk of developing Placenta Accreta is very high.
- Previous uterine surgery: If you have had other surgeries, such as removal of uterine fibroids or D&C (dilation and curettage), this risk may also increase due to scarring.
- Multiple pregnancies: This risk may increase slightly with more children.
- Pregnancy through IVF: Some studies have shown that this risk is also slightly higher for mothers who conceived through IVF.
Most importantly, with the increase in C-sections these days, Placenta Accreta is also more common than before. So it's important to be aware of this.
Does Placenta Accreta Affect the Baby?
In most cases, Placenta Accreta does not directly harm the baby, as the placenta continues to provide the baby with the nutrients and oxygen it needs. However, the main risk here is preterm birth .
To prevent excessive bleeding due to placenta accreta, doctors plan to perform a C-section a few weeks before your due date. Usually between 34-37 weeks. Delivering the baby this early can cause complications that come with premature birth, such as low birth weight and breathing difficulties. At that time, the baby may need to be admitted to the neonatal intensive care unit (NICU) for special care.
What are the risks for the mother?
The main risk in Placenta Accreta is to the mother. This is the main reason why it is considered a high-risk pregnancy.
- Heavy bleeding: This is the most dangerous and common complication. When the placenta is delivered after the baby is born, there can be uncontrollable bleeding.
- Damage to the uterus and surrounding organs: If the placenta has penetrated the uterine wall (percreta), organs such as the bladder and intestines can also be damaged.
- Hysterectomy: If there is no other way to stop the heavy bleeding, the uterus may have to be completely removed to save the mother's life. This will result in the loss of the ability to have children in the future.
- Blood clotting problems, lung or kidney failure: If you bleed excessively, it can affect other systems in the body.
- Death: Although very rare, if not recognized early and treated properly , excessive bleeding can even be life-threatening to the mother.
These risks can be scary to see. But remember, if this condition is identified early , the medical team can manage many of these risks and save the mother's life.
What are the symptoms of this condition?
Most of the time, the mother does not experience any symptoms of Placenta Accreta. That is the slightly more dangerous part of this. You can develop this condition internally without any discomfort or pain.
However, some women may experience vaginal bleeding during the third trimester of pregnancy (after 28 weeks). Also, if the placenta presses on an organ, such as the bladder, it can cause pelvic pain.
Most importantly, it is extremely important to diagnose this condition through ultrasound scans during pregnancy, as it often does not cause any symptoms.
How do doctors find this?
Fortunately, Placenta Accreta can be detected most often during routine scans during pregnancy. During the scan, your doctor will pay special attention to the position of the placenta and how it is attached to the uterus.
- Ultrasound Scan: This is the most basic and important diagnostic method. The doctor will carefully examine the connection between the placenta and the old scar, especially if you have had a previous C-section.
- MRI Scan (Magnetic Resonance Imaging): In some cases, an MRI scan may be performed to further confirm how deep the placenta has penetrated and whether it has attached to other organs.
Sometimes, if the scan doesn't detect it, doctors only find out if the placenta doesn't separate after the baby is born. But it's best to detect it early . Then everything can be planned in advance for the birth. Specialist doctors, a blood bank, and even a neonatal intensive care unit (NICU) can be arranged if needed.
What are the treatments for Placenta Accreta?
Once this condition is diagnosed, you will be treated by a multidisciplinary team, including gynecologists, anesthesiologists, and sometimes urologists.
The treatment method depends on the severity of your condition.
- Planned C-section: The main treatment is a planned, early C-section . This is usually done between 34 and 37 weeks. This is done to deliver the baby before you start having labor pains. This is because if your uterus starts to contract, there can be a lot of bleeding from the placenta.
- Cesarean Hysterectomy: In severe cases, especially if there is Placenta Increta or Percreta, the safest option is to remove the uterus at the same time as the C-section. Here, after the doctor delivers the baby, the uterus is completely removed along with the placenta , without trying to remove the placenta. This can prevent excessive bleeding and save the mother's life.
- Attempts to save the uterus: If you want to have more children in the future, and the condition is not too severe, your doctor may try to save the uterus. However, this is a very risky and complicated procedure. Sometimes, part of the placenta may have to be left in the uterus. This can cause problems later, such as infection and bleeding.
Your doctor will explain to you the best and safest treatment option for your condition.
Things to ask your doctor
When you find out that you have Placenta Accreta, it's normal to have a lot of questions in your mind. Don't be afraid. Ask your doctor to clarify these questions.
- Will I have the baby early?
- What is the right treatment for me?
- Do I need to make changes to my daily routine? Do I need bed rest?
- What symptoms should I go to the hospital immediately if I develop?
- Can I not have a vaginal delivery?
- Will I be able to have another child in the future?
- What are the chances that I will need a hysterectomy?
The answers to these questions will help you mentally prepare to deal with this situation.
What to do in an emergency?
If you know you have Placenta Accreta, your doctor will monitor you very closely. However , if you experience heavy bleeding that soaks a pad in less than an hour during pregnancy, or if you experience severe lower abdominal pain , it is an emergency. Go to the hospital's Emergency Department (ETU) immediately.
Take-Home Message
- Placenta Accreta is a serious condition in which the placenta attaches too deeply to the uterine wall.
- The main risk factor is having had a previous C-section.
- This condition often has no specific symptoms, which is why scans during pregnancy are very important.
- Early detection and planning of delivery can greatly reduce the risks to mother and baby.
- Treatment is often a planned C-section, and in severe cases, a hysterectomy may be necessary to save the mother's life.
- If you have any questions or concerns about this, talk to your doctor openly about it. With the right knowledge and proper medical treatment, this condition can be successfully managed.
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