We all understand how precious a time pregnancy is, not just for the pregnant person but for the entire family. It represents an opportunity for a new beginning and a time filled with excitement and dreams. Although most pregnancies remain healthy and result in healthy babies, sometimes complications can arise.  These can include conditions like placenta accreta that make things harder. Placenta accreta? It might sound like a new and unfamiliar word and, if it’s your first time hearing it, you're not the only one. It was a new word to me too, but let us learn about it together. 

Placenta accreta is uncommon (1 in 533 pregnancies) but needs prompt intervention as it can cause complications for both the pregnant parent and their baby. We all understand the role of the placenta in nourishing the growing baby,¹ Placenta accreta occurs when the placenta attaches too deeply to the uterine wall, potentially leading to life-threatening hemorrhage during delivery. Sometimes when this abnormal attachment occurs, the placental villi also invade the muscles of the uterus or extend beyond the uterine wall.²

Despite its rarity, the impact of placenta accreta cannot be overlooked. Although rare, its potential for serious complications reminds us to promptly seek advice from our healthcare provider for any unusual symptoms that we notice during pregnancy.

In this article, we will explore every aspect of placenta accreta, its causes, symptoms, diagnosis, and treatment options. We will also study possible solutions, and examine the benefits and considerations associated with each approach.

Who is at risk?

It is important to identify individuals who may be more at risk of developing placenta accreta. This can promote early detection and proactive management of this serious condition. Although placenta accreta can affect any pregnant individual, certain factors may make it more likely to happen.²

These include:

• Previous Caesarean deliveries
• Previous surgeries involving the uterus 
• Multiple previous pregnancies (multiparity)
• Pregnancies conceived via IVF
• Smoking
• Age of pregnant parent >35 years old

Symptoms of placenta accreta

Placenta accreta may not always be present with noticeable symptoms. Still, it’s important to recognise the warning signs in order to discover the condition at an early stage and treat it appropriately. Recognising these may help medical professionals and pregnant parents identify the condition and ensure optimal measures to reduce complications.³

Symptoms of placenta accreta may include:

• Abnormal bleeding during pregnancy, usually in the third trimester (weeks 28 to 40)
• Persistent pelvic pain (from the placenta pressing on the bladder)
• Fetal malpresentation (baby not positioned head-down towards the birth canal) 

How is placenta accreta diagnosed?

An early diagnosis of placenta accreta is important as it enables healthcare professionals to devise a comprehensive management plan and tailor it to the individual’s needs.⁴ There are certain tests that can be performed to diagnose this complex situation.

• Prenatal screening
• Ultrasound
• Magnetic Resonance Imaging (MRI)
• Biopsy or pathological examination (rarely)

Now that we have discussed the diagnosis of placenta accreta, it’s crucial to emphasise that once the condition is confirmed, all efforts should be directed towards its treatment and management. This complex condition requires prompt and comprehensive intervention to minimise risks and optimise outcomes for both the pregnant parent and baby. One such solution that healthcare providers may consider for placenta accreta is a hysterectomy. This would be done following the birth of the baby, usually via an early planned Caesarean section.⁴

Hysterectomy

Hysterectomy is an open surgical procedure that removes the uterus (also called the womb) and serves to be a definitive treatment option to control bleeding and prevent serious blood loss that could be fatal. In severe cases, this technique is often regarded as the safest option. Hysterectomy efficiently eliminates the source of bleeding and prevents further complications associated with placenta accreta. Apart from its role in handling placenta accreta, a hysterectomy can also be suggested as a preventative step when there is an elevated risk of potentially fatal haemorrhage following delivery.⁵

This procedure can be performed through different approaches including:

• Abdominal hysterectomy (through an incision in the abdomen)
• Vaginal hysterectomy (through the vagina)
• Laparoscopic hysterectomy (minimally invasive surgery with minor incisions and a camera)

However, it should be noted that following a hysterectomy, conception is no longer possible, and options for having more children may need to be via alternatives such as surrogacy or adoption. Therefore, the decision to proceed with a hysterectomy is not taken lightly and involves thorough discussion and consideration of the pregnant person’s individual circumstances and preferences. Open communication and shared decision-making are paramount. Additionally, understanding the recovery process and long-term effects of hysterectomy is crucial before undergoing this procedure. 

Long-term implications of hysterectomy include:⁶

• Early start of menopause
• Symptoms such as hot flashes, vaginal dryness and mood changes
• Impact upon hormonal balance
• Psychological implications
• Conception becomes impossible
• Emotional distress

Up to this point, we have explored the role of hysterectomy as an important intervention for treating placenta accreta. While it serves as an effective solution in controlling bleeding and reducing the risk of fatal haemorrhage, it also comes with implications. Thus, this approach requires a firm decision to proceed and requires careful consideration and collaboration betweenthe pregnant parent, healthcare providers, and any specialists involved. It involves weighing the risks and benefits, understanding the implications for future fertility, and ensuring that the chosen course of actions aligns with the results.

Summary

This article discusses placenta accreta, a rare but serious problem during pregnancy. It is vital to diagnose it and manage it properly. One treatment option for severe cases is hysterectomy, a surgery to remove the uterus. However, there are major effects from this procedure. It results in infertility and may trigger early menopause, characterised by mood swings and hot flashes. A hysterectomy is a difficult decision that has to be carefully considered with medical professionals. Our intention is to draw attention to how crucial it is to make well-informed decisions in collaboration with medical experts in order to guarantee the best possible care and results for the pregnant parent and their child.