As a mother, you sometimes have little fears about things, don't you? Especially when you're about to have a baby, about the placenta. Today we're going to talk about a condition that some mothers may experience during pregnancy, but you should be a little careful about, and it can even be dangerous. That's a condition called (Placenta Accreta) .
What is (Placenta Accreta)? Simply put...
Simply put, Placenta Accreta is when the placenta, which provides your baby with nutrients and oxygen , attaches too deeply to the wall of your uterus. In a normal pregnancy, this placenta easily detaches from the uterine wall after the baby is born. However, in the case of Placenta Accreta, the placenta is so attached to the uterine wall that it does not detach easily after the baby is born.
Think of it this way, just like when a plant is planted in the ground, its roots normally spread out, in a healthy pregnancy the placenta attaches to the uterine wall. However, in Placenta Accreta, the roots of that plant go deeper than expected, perhaps as if they had gone right into something hard like concrete, and the placenta has penetrated the muscular layer of the uterine wall and is firmly attached.
In severe cases, this can lead to heavy vaginal bleeding. It can be life-threatening. In this case, you may need a blood transfusion (i.e., a blood transfusion) and a hysterectomy. Doctors who provide prenatal care often diagnose the condition during pregnancy, or sometimes during labor. Treatment usually involves delivering the baby by planned cesarean delivery (C-section) to reduce the risk of serious complications, followed by a hysterectomy.
Are there different types of Placenta Accreta?
Yes, there are three main types of Placenta Accreta. Doctors determine these types based on how deeply the placenta is attached to your uterus.
1. Placenta Accreta: This is the most common type. Here, the placenta adheres tightly to the uterine wall, but does not extend through the wall and does not significantly affect the uterine muscles.
2. Placenta Increta: In this type, the placenta attaches deeper into the uterine wall, into the muscle layer. It has not yet completely penetrated the wall, but it is firmly attached to the uterine muscles. This occurs in about 15% of all Placenta Accreta cases.
3. Placenta Percreta: This is the most severe and dangerous case. Here, the placenta completely penetrates the uterine wall. It can even go beyond the uterus and affect other organs in your body, such as the bladder and intestines, or even stick to them. This only occurs in a small number of people, about 5%.
Who is at higher risk of developing Placenta Accreta?
You are at higher risk of developing Placenta Accreta if you have any of the following conditions:
- If you have had previous cesarean deliveries: The risk is higher, especially if you have had multiple cesarean deliveries, because the uterine scar may form at the site of the surgery.
- If the placenta is in an abnormal position in your uterus: For example, if you have a condition called ``Placenta Previa``, where the placenta is in the lower part of the uterus, covering the cervix.
- If you have had previous uterine surgery: If you have had surgeries such as removal of uterine fibroids or D&C (dilation and curettage), this condition can occur due to scarring in those areas.
- If you have had multiple pregnancies (`more than one pregnancy`) before.
- If you have become pregnant through IVF (artificial insemination).
Imagine, you have a friend, let's say Nimali. Nimali has had two previous babies by cesarean section. Now that she is pregnant with her third baby, the doctor tells her that she needs to be a little more careful about the position of the placenta. Because she has had a previous cesarean section, there may be fine scars on the uterus where the surgery was performed. That is why the risk of developing (Placenta Accreta) increases.
Will Placenta Accreta harm the baby?
Placenta Accreta does not directly harm the baby. However, this condition can often lead to premature birth (preterm birth). This means that the baby can be born before 37 weeks. Babies born prematurely have risks such as breathing difficulties and problems gaining weight. Also, there is a higher chance that the baby will be admitted to the Neonatal Intensive Care Unit (NICU) for special treatment.
What are the risks to the mother due to Placenta Accreta?
This may sound a little scary, but it's important to know. A mother with Placenta Accreta may be at risk for:
- Premature birth.
- Damage to the uterus and surrounding organs such as the bladder and intestines.
- Loss of fertility due to hysterectomy.
- Excessive bleeding, resulting in the need for a blood transfusion.
- Blood clotting issues.
- Lung or kidney failure.
- In very rare cases, death can even occur. That is why this condition is considered very serious.
How common is Placenta Accreta?
Placenta Accreta is said to affect about 1 in 533 pregnancies. However, the incidence of this condition has increased in recent decades. The main reason for this is thought to be the increase in the number of cesarean sections (C-sections).
What are the causes of Placenta Accreta?
Placenta Accreta is mainly caused by some abnormalities in the lining of your uterus. Your uterine lining may have been damaged and scarred by previous hysterectomy surgeries. But sometimes this condition can also occur in people who have never had any hysterectomy, right?
The main risk factors for Placenta Accreta are:
- Previous Cesarean Sections (`Multiple C-sections`): Women who have had multiple Cesarean sections are at higher risk of developing Placenta Accreta. This is because the scars that form on the uterus from those surgeries can be severe. The risk increases with the number of Cesarean sections performed over time. More than 60% of Placenta Accreta cases have had a previous Cesarean section.
- Previous uterine surgeries: If you have had surgery to remove uterine fibroids (which are non-cancerous tumors), the scarring can lead to placenta accreta. Also, surgeries such as curettage (D&C) or endometrial ablation can also cause scarring, leading to this condition.
- Placenta Previa: In this condition, the placenta is located covering the cervix. For those with Placenta Previa and those who have had previous cesarean sections, the risk of developing Placenta Accreta increases with the number of cesarean sections performed.
What are the symptoms of Placenta Accreta?
Most of the time, people with Placenta Accreta do not show any specific symptoms. That is something to think about. However, some people may experience some vaginal bleeding during the third trimester of pregnancy (i.e., from weeks 28 to 40), or they may experience lower abdominal pain as the placenta presses on the bladder or other organs.
How to recognize (Placenta Accreta)?
Placenta Accreta can be diagnosed with an ultrasound scan during pregnancy. Sometimes , a Magnetic Resonance Imaging (MRI) test may be done to see exactly how deep the placenta has embedded itself into the uterine wall.
In other cases, doctors only discover Placenta Accreta after the baby is born. Usually, the uterus contracts and the placenta comes out within 30 minutes of the baby being delivered. If this doesn't happen, the doctor may suspect Placenta Accreta.
How important is early detection of Placenta Accreta?
It is extremely important to recognize this condition early.
Because then, during your pregnancy and after your baby is born, different healthcare providers, that is, different specialists, can come together to plan the best treatment for you and your baby. For example, a neonatologist may be involved in your baby's care, or a perinatologist may be involved in your care. Your doctor will monitor you very closely and work to provide the best outcome for you and your baby.
By involving the right medical team, you may be able to avoid a hysterectomy or prevent life-threatening heavy bleeding. In some severe cases, early detection may not prevent a hysterectomy or blood transfusion. However, early detection can greatly reduce the risk of other complications.
How is Placenta Accreta treated?
Treatment for this can vary from person to person. If your doctor detects it before your baby is born, they will monitor you closely throughout your pregnancy. You may be asked to stay in the hospital or to take bed rest at home to help prevent premature birth.
Your doctor will schedule a C-section (cesarean section) to deliver your baby, usually between 34 and 37 weeks of pregnancy. This is to prevent excessive bleeding that could occur from uterine contractions or labor. If you are planning to have more children, your doctor will try to save your uterus.
However, in severe cases where the placenta is very deep, very attached, or has affected other organs, a hysterectomy is the safest option. A cesarean hysterectomy is a procedure in which the uterus is removed at the same time as the baby is delivered by C-section. In this procedure, the doctor removes the baby and both the uterus and placenta at the same time. Removing the uterus while the placenta is still attached can greatly reduce the risk of excessive bleeding.
Some doctors choose to leave small pieces of the placenta inside the uterus, as the placenta will dissolve over time. However, this also has risks such as heavy vaginal bleeding, infection, and blood clots. It can also make it difficult to get pregnant in the future.
How early do you deliver the baby when you have (Placenta Accreta)?
Most doctors recommend a C-section between 34 and 37 weeks of pregnancy , unless there are other complications. This is to prevent you from having contractions or starting labor, which can cause excessive bleeding. Your doctor may also give you a medicine called corticosteroids to help your baby's lungs develop.
Can Placenta Accreta be prevented?
There is no way to completely prevent Placenta Accreta. However, if you have had multiple C-sections or have a placenta previa, your risk is higher. Talk to your doctor about your health history and what your risk is for developing Placenta Accreta.
What is the future for those with (Placenta Accreta)?
Placenta Accreta, if diagnosed early in pregnancy, usually has a good outcome. However, it can lead to complications such as premature birth and hysterectomy. If your doctor removes your uterus, you will not be able to get pregnant again. This condition can cause heavy bleeding, damage to your intestines or bladder, and even death. This is why it is a condition that requires a lot of care.
Is it possible to have a baby again after Placenta Accreta?
This depends on whether you have had a hysterectomy (surgery to remove your uterus). If you want to have more children in the future, talk to your doctor about it. He or she may be able to avoid a hysterectomy to preserve your fertility (ability to have children).
What is the chance of surviving Placenta Accreta?
The survival rate for Placenta Accreta is generally good. In many cases, a hysterectomy is required to prevent postpartum hemorrhage or other serious complications.
When should I call my doctor?
Placenta Accreta is a high-risk pregnancy condition. Your doctor will monitor you closely and keep you informed about the rest of your pregnancy, delivery, and recovery. If you have any questions about this diagnosis, ask them. They are there to help you.
If you suddenly start bleeding heavily (so much that you wet a pad in less than an hour) or if you experience severe pain in your lower abdomen, call 911 immediately or go to the nearest hospital immediately.
What questions should I ask my obstetrician and gynecologist?
It's normal to have a lot of questions when you find out you have Placenta Accreta. Here are some common questions you can ask your doctor:
- Will I have to deliver the baby early?
- How is this condition treated?
- Do I need to take bed rest or change my daily routine?
- How do I know when I need to go to the hospital?
- Is it possible to deliver the baby normally (vaginally)?
- Will I be able to have another baby in the future?
- Will I have to have a hysterectomy?
Will a hysterectomy be necessary due to Placenta Accreta?
Your doctor will do their best to save your uterus, but doing so may be very risky. In many cases of severe placenta accreta, the uterus may need to be removed to prevent life-threatening bleeding. Talk to your doctor about whether a hysterectomy is necessary for your situation.
What can we learn from this? (Take-Home Message)
Placenta Accreta is a condition that usually does not cause any symptoms during pregnancy, but it can be life-threatening. However, early detection and careful monitoring with an ultrasound scan can reduce the risk of complications. Sometimes the condition is only discovered after the baby is born. If you have Placenta Accreta, talk to your doctor about what to expect. Remember, they are there to keep you and your baby safe and healthy. So don't be afraid to talk to them about your concerns and what's on your mind.
` Placenta, Uterus, Pregnancy, Cesarean Section, Childbirth, Bleeding, Placenta Accreta, Women's Health, Pregnancy Complications
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