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Placenta Accreta

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Introduction

Placenta Accreta is a high-risk complication of pregnancy; it can even be life-threatening to mothers.

During a typical pregnancy, the placenta attaches to the wall of the uterus. It then detaches itself from the uterus after childbirth.

In Placenta Accreta, the placenta continues to be attached to the uterine wall—either partly or entirely. Excessive bleeding occurs post-delivery due to the firm attachment of the placenta. The blood loss can be fatal, making Placenta Accreta a severe complication.

In some cases, the placenta adheres to the uterine muscles (placenta increta) or grows into the uterus wall (placenta percreta).

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What are the Causes of Placenta Accreta?

The exact cause of Placenta Accreta remains unknown. However, there is evidence to link Placenta Accreta and pre-existing irregularities in the uterus.

The irregularities in the uterus are often due to scarring. Scars in the uterus allow the placenta to grow into the uterine walls. It may be from previous cesarean deliveries or any other surgeries involving the uterus. Cesarean deliveries can predispose a woman to an increased risk of Placenta Accreta.

Placenta previa (a condition where the placenta covers the mother’s cervix either partially or entirely) also associates with a high risk of developing Placenta Accreta.

Uterine abnormalities such as fibroids can also increase the risk.

In some cases, Placenta Accreta occurs without any previous history of uterine irregularities and abnormalities. Women over 35 years of age are at increased risk of developing this condition.

What are the Symptoms of Placenta Accreta?

Placenta Accreta often displays no signs or symptoms throughout the pregnancy. It is usually detected either during childbirth or during routine ultrasound scans.

In some cases, women report bleeding in the vagina during the third trimester (last three months of pregnancy).

If you experience excessive bleeding during your third trimester, it can be an emergency, especially if accompanied by abdominal pain. Contact your doctor immediately.

How is Placenta Accreta Diagnosed?

Typically, routine ultrasounds during pregnancy can detect Placenta Accreta. If you are at risk of developing the condition, your doctor can advise you on specific diagnosing tests to detect Placenta Accreta.

An imaging test, such as ultrasound or MRI, can diagnose the condition. These tests can help detect the presence and extent of placental attachment in the uterine walls. Additionally, a blood test for increased alpha-fetoprotein can also help with the diagnosis.

How is Placenta Accreta Treated?

Every case of placenta accreta differs; treatment requires an individualised approach. If you are diagnosed with placenta accreta, a team of doctors will work with you to ensure a safe pregnancy and childbirth. The team of health care providers will include a gynaecologist, obstetrician, and paediatrician.

Usually, pregnancies with placenta accreta require cesarean section surgeries to deliver the baby safely.

If you experience bleeding through the vagina in the third trimester, your doctor may advise rest to prevent further complications.

In severe cases of placenta accreta, your doctor may advise you to undergo a hysterectomy (surgery for removing the uterus). The doctors will deliver the baby through a cesarean surgery first, followed by the hysterectomy. It is to prevent severe blood loss and the resulting complications following childbirth.

Removing the uterus prevents future pregnancy. Sometimes, if you wish to be pregnant again, your doctors may leave the placenta in your body. The placenta dissolves itself over time. However, it can lead to complications, including:

  • ● Vaginal bleeding
  • ● Infections
  • ● Blood clotting problems
  • ● Need for hysterectomy in future

What is the Results of Placenta Accreta Treatment?

The outlook of Placenta Accreta is promising if the condition has an early diagnosis and receives prompt treatment. Most women can expect a full recovery without complications.

If you have to undergo a hysterectomy to treat the condition, you will lose the ability to become pregnant again. If the placenta is left intact to dissolve by itself, it can lead to severe complications. Leaving the placenta and avoiding hysterectomy is not always advisable as it increases the risk of Placenta Accreta in a future pregnancy.

What are the Risks Associated with Placenta Accreta treatments?

The risks of surgery for cesarean and hysterectomy are the same as that of any other surgeries. They include:

  • ● Reaction to anaesthesia
  • ● Infection
  • ● Blood clots
  • ● Excessive bleeding

Hysterectomy can have a long term effect on your body. The effects include:

  • ● Prolapse of the pelvic floor
  • ● Urinary incontinence
  • ● Bowel incontinence
  • ● Sexual dysfunction
  • ● Hormonal imbalance

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FAQ's

Is Placenta Accreta Common?

Placenta Accreta is not a common disorder. It occurs in about 0.2% of all pregnancies. It is more prevalent in women over 35 years of age.

Is Placenta Accreta Painful?

Typically, Placenta Accreta has no signs or symptoms. Some may experience vaginal bleeding in the third trimester. The treatment for placenta accreta involving cesarean surgery and hysterectomy may be painful for a short duration; the disorder itself is not painful.

Can you have Another Baby After Placenta Accreta?

The treatment of Placenta Accreta involves surgical removal of the uterus to stop the excessive bleeding after childbirth. Such a procedure renders you unable to bear children in the future. Sometimes doctors may allow the placenta to remain intact, allowing it to dissolve on its own. Although it will spare your uterus, allowing you to get pregnant again, it has complications.
Women with a history of Placenta Accreta and have avoided hysterectomy are at an increased risk of recurrent Placenta Accreta with subsequent pregnancies.

How Serious is Placenta Accreta?

Placenta Accreta is a high-risk complication of pregnancy and can be fatal. It poses a risk of severe bleeding through the vagina after delivery. The bleeding can be life-threatening as it can lead to blood clotting abnormalities, lung and kidney failure.

Can Placenta Accreta be Prevented?

Placenta Accreta is not a preventable condition. If you are diagnosed with the disorder, your doctor will monitor your condition to deliver without complications.

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