Guide | Understanding Placenta Accreta Spectrum: A Rare but Serious Pregnancy Complication
Placenta accreta is a rare but serious pregnancy complication affecting about 0.2% of pregnancies. Normally, the placenta attaches to the endometrium, the inner lining of the uterine wall, and separates naturally after delivery. With placenta accreta, it grows more deeply into the uterine wall and may extend into surrounding organs, creating potential risks for the pregnant woman and fetus.
What is the placenta?
The placenta is the tissue connecting mother and fetus. It delivers blood, oxygen, and nutrients to the fetus and removes waste. It normally separates from the uterine lining after delivery. Placenta accreta occurs when it attaches too firmly or grows into the uterine wall.
Types of placenta accreta spectrum
There are three main types, classified by the depth and extent of placental attachment:
Placenta Accreta: The mildest type, in which the placenta attaches to the surface of the uterine wall.
Placenta Increta: A moderate form in which the placenta grows into the uterine muscle.
Placenta Percreta: The most severe form, in which the placenta penetrates the uterine wall and may invade nearby organs such as the bladder.
Causes and risk factors
The incidence has risen substantially, from 1/30,000 pregnancies in the 1960s to 1/533 in the 2000s. A major reason is the increase in cesarean delivery, because uterine scars from the procedure raise the risk of abnormal placental attachment in later pregnancies.
Risk increases with the number of cesarean deliveries, from 0.3% after one to as high as 6.7% after five or more. Other procedures that scar the uterus also increase risk, including myomectomy, hysteroscopic surgery, uterine embolization, and pelvic radiation therapy. Additional risk factors include:
Age over 35
Placenta previa, in which the placenta partly or completely covers the cervix, present in 80% of placenta accreta cases
Multiple previous deliveries
Asherman syndrome, involving scar tissue inside the uterus
Diagnosis
Placenta accreta is usually diagnosed by ultrasound. Clinicians may specifically assess placental attachment in high-risk patients. Magnetic resonance imaging (MRI) may be needed to define the depth and extent more clearly. Even with advanced imaging, accurately determining the degree of invasion can be challenging.
Complications
The main risks arise during delivery. If the placenta does not detach normally, serious maternal and fetal complications can occur:
Fetal complications
Increased risk of preterm birth, often requiring a planned cesarean delivery 3 to 6 weeks early.
The newborn may require neonatal intensive care (NICU).
Maternal blood loss may require emergency delivery.
Maternal complications
Severe bleeding: Postpartum hemorrhage is the most dangerous complication and may be life-threatening.
Vaginal delivery may not be possible: Cesarean delivery and further procedures may be required to remove the placenta.
Hysterectomy: Removal of the uterus may be necessary to remove the placenta completely and control bleeding, ending future fertility.
Treatment and care
Treatment depends on the depth of placental attachment. Delivery at a fully equipped hospital is usually recommended so emergencies such as massive bleeding and urgent transfusion can be managed. In most cases, cesarean delivery followed by hysterectomy is the preferred approach.
For patients who wish to preserve fertility, doctors may try to remove only part of the placenta, but this increases the risks of infection and later surgery. Retained placental tissue may rarely dissolve and be absorbed by the body.
The greatest danger occurs when placenta accreta is unrecognized and vaginal delivery is attempted, potentially causing massive blood loss and requiring immediate emergency care.
Recovery after delivery
Recovery may be more complex than after a routine delivery. Patients with severe blood loss may need 1 to 2 days in the intensive care unit (ICU). Hospitalization usually lasts 3 to 5 days, similar to a cesarean delivery. Frequent follow-up may be needed to monitor the patient and newborn.
Every pregnancy is different, and an individualized delivery and treatment plan is essential for maternal and infant safety.
Guide | Understanding Placenta Accreta Spectrum: A Rare but Serious Pregnancy Complication
Guide | Understanding Placenta Accreta Spectrum: A Rare but Serious Pregnancy Complication
Placenta accreta is a rare but serious pregnancy complication affecting about 0.2% of pregnancies. Normally, the placenta attaches to the endometrium, the inner lining of the uterine wall, and separates naturally after delivery. With placenta accreta, it grows more deeply into the uterine wall and may extend into surrounding organs, creating potential risks for the pregnant woman and fetus.
What is the placenta?
The placenta is the tissue connecting mother and fetus. It delivers blood, oxygen, and nutrients to the fetus and removes waste. It normally separates from the uterine lining after delivery. Placenta accreta occurs when it attaches too firmly or grows into the uterine wall.
Types of placenta accreta spectrum
There are three main types, classified by the depth and extent of placental attachment:
Placenta Accreta: The mildest type, in which the placenta attaches to the surface of the uterine wall.
Placenta Increta: A moderate form in which the placenta grows into the uterine muscle.
Placenta Percreta: The most severe form, in which the placenta penetrates the uterine wall and may invade nearby organs such as the bladder.
Causes and risk factors
The incidence has risen substantially, from 1/30,000 pregnancies in the 1960s to 1/533 in the 2000s. A major reason is the increase in cesarean delivery, because uterine scars from the procedure raise the risk of abnormal placental attachment in later pregnancies.
Risk increases with the number of cesarean deliveries, from 0.3% after one to as high as 6.7% after five or more. Other procedures that scar the uterus also increase risk, including myomectomy, hysteroscopic surgery, uterine embolization, and pelvic radiation therapy. Additional risk factors include:
Age over 35
Placenta previa, in which the placenta partly or completely covers the cervix, present in 80% of placenta accreta cases
Multiple previous deliveries
Asherman syndrome, involving scar tissue inside the uterus
Diagnosis
Placenta accreta is usually diagnosed by ultrasound. Clinicians may specifically assess placental attachment in high-risk patients. Magnetic resonance imaging (MRI) may be needed to define the depth and extent more clearly. Even with advanced imaging, accurately determining the degree of invasion can be challenging.
Complications
The main risks arise during delivery. If the placenta does not detach normally, serious maternal and fetal complications can occur:
Fetal complications
Increased risk of preterm birth, often requiring a planned cesarean delivery 3 to 6 weeks early.
The newborn may require neonatal intensive care (NICU).
Maternal blood loss may require emergency delivery.
Maternal complications
Severe bleeding: Postpartum hemorrhage is the most dangerous complication and may be life-threatening.
Vaginal delivery may not be possible: Cesarean delivery and further procedures may be required to remove the placenta.
Hysterectomy: Removal of the uterus may be necessary to remove the placenta completely and control bleeding, ending future fertility.
Treatment and care
Treatment depends on the depth of placental attachment. Delivery at a fully equipped hospital is usually recommended so emergencies such as massive bleeding and urgent transfusion can be managed. In most cases, cesarean delivery followed by hysterectomy is the preferred approach.
For patients who wish to preserve fertility, doctors may try to remove only part of the placenta, but this increases the risks of infection and later surgery. Retained placental tissue may rarely dissolve and be absorbed by the body.
The greatest danger occurs when placenta accreta is unrecognized and vaginal delivery is attempted, potentially causing massive blood loss and requiring immediate emergency care.
Recovery after delivery
Recovery may be more complex than after a routine delivery. Patients with severe blood loss may need 1 to 2 days in the intensive care unit (ICU). Hospitalization usually lasts 3 to 5 days, similar to a cesarean delivery. Frequent follow-up may be needed to monitor the patient and newborn.
Every pregnancy is different, and an individualized delivery and treatment plan is essential for maternal and infant safety.
Source:
Collected online