What You Should Know About Placenta Accreta

Pregnancy is a remarkable journey, where a mother’s uterus and placenta nourish the developing fetus with oxygen and nutrients. Ideally, the placenta should attach to the uterus during pregnancy so that these essential life requirements can pass without harm to the mother or child. However, the medical team caring for the mother and child must be aware of potential complications, such as placenta accreta.

Why is placenta accreta dangerous?

The Mayo Clinic states that placenta accreta occurs when the “placenta grows too deeply into the uterine wall.” After a child is delivered the placenta should detach from the uterine wall. Placenta accreta is a condition where some or all of the placenta stays attached which can cause severe blood loss. Other placental disorders include:

• Placenta increta, where the placenta invades the uterine muscles.
• Placenta percreta, where the placenta grows through the uterine wall.

If placenta accreta is diagnosed during pregnancy, the mother will normally need a Cesarean (C-section) delivery and a hysterectomy (surgical removal of the uterus).

While placenta accreta may present with vaginal bleeding in the third trimester, it often exhibits no noticeable symptoms during pregnancy. In some cases, it is detected during a routine ultrasound.

One possible cause of placenta accreta is abnormalities in the line of the uterus, “typically due to scarring after a C-section or other uterine surgery.”

What are the risk factors for placenta accreta?

Some of the many risk factors that doctors should review with mothers include:

• A prior uterine surgery: The more C-sections or other uterine surgeries a woman has, the more the risk of placenta accreta increases.
• The position of the placenta: The risk of placenta increases if “the placenta partially or totally covers your cervix (placenta previa) or sits in the lower portion of your uterus.”
• Age: The risk of placenta accreta increases for women older than 35.
• A prior childbirth:The risk of placenta accreta increases with the number of prior pregnancies.

What are the possible complications of placenta accreta?

The dangers associated with placenta accreta include:

• Heavy vaginal bleeding:Placenta accreta creates a severe risk of severe vaginal bleeding (hemorrhage) after delivery. The hemorrhaging can be life-threatening if it prevents the mother’s blood from clotting normally (disseminated intravascular coagulopathy) or causes lung failure (adult respiratory distress syndrome) or kidney failure. The remedy is normally a blood transfusion.
• Premature birth: Placenta accreta may trigger early labor, often requiring preterm delivery if bleeding occurs during pregnancy.

How is placenta accreta diagnosed and treated?

Doctors should evaluate the placental attachment and depth using MRI or ultrasound if risk factors for placenta accreta are present. Treatment involves planning a safe delivery for the baby.

In the case of extensive placenta accreta, a C-section followed by the surgical removal of the uterus (hysterectomy) might be necessary. This procedure, also called a cesarean hysterectomy, helps prevent the potentially life-threatening blood loss that can occur if there’s an attempt to separate the placenta.

Pelvic rest or hospitalization may be recommended if the mother has vaginal bleeding during the third trimester.

If surgery is required, medical team should review with you the risks and possible complications associated with placenta accreta, the possibility of a blood transfusion, and the need to be admitted to an ICU after the delivery is the bleeding is life-threatening.

Why doctors can be held liable for placenta accreta complications

The OB/GYNs and other members of the pregnancy medical team may be liable for medical malpractice if placenta accreta causes harm for the following reasons:

• A misdiagnosis or a delayed diagnosis: Doctors who fail to recognize the signs of placenta accreta and the risks of placenta accreta can delay a proper diagnosis. This delay can mean that treatments and interventions that could have saved the life of the mother or prevented organ damage or other harm to the mother or child cannot be provided.
• Failure to review the risk factors: Doctors may be liable for medical malpractice if they fail to review whether a mother has any of the risk factors for developing placenta accreta. This failure can mean that the doctor doesn’t conduct MRIs, ultrasounds, or other tests to detect placenta accreta in a timely manner.
• Improper treatments: The mother’s doctors should understand what steps and procedures to take if placenta accreta develops before or during the delivery of a child. There are standard protocols that doctors should follow. Doctors should be prepared to conduct C-sections, hysterectomies, and other treatments in a prompt and competent manner.
• Surgical errors: Doctors who perform any surgical procedure such as a C-section are required to perform the procedure according to proper medical standards. Failure to follow these standards may be medical malpractice.

The birth of a child should be the sweet joy of life for the mother and father. If placenta accreta is not recognized and treated properly, the consequences can be catastrophic.

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