Introduction

Placenta accreta is a condition that affects pregnant individuals and poses significant risks to expectant mothers and their babies. It occurs when the placenta, the organ responsible for supplying nutrients and oxygen to the foetus, abnormally attaches itself to the wall of the uterus. The placenta attaches more deeply and invasively than it would in a typical pregnancy, leading to potential complications during childbirth.

Understanding the details of placenta accreta, including its causes and symptoms, is crucial for both healthcare providers and expecting parents. By understanding the risk factors for and potential consequences of placenta accreta, we can better appreciate the gravity of the condition and the importance of early detection and intervention.

Your risk of placenta accreta can be increased by various factors, such as:

• Previous uterine surgeries, like caesarean sections or myomectomy 
• Placenta previa and uterine abnormalities 
• Advanced maternal age 
• Using assisted reproductive technologies

Spotting the symptoms of placenta accreta can be challenging, but awareness can make a significant difference. Symptoms may include:

• Abnormal vaginal bleeding 
• Pelvic pain 
• Complications during delivery (such as the failure of the placenta to detach postpartum)

While the medical jargon surrounding placenta accreta may seem daunting, grasping its significance is vital for potential patients and healthcare providers. By familiarising ourselves with the causes and symptoms of placenta accreta, we empower ourselves to seek timely medical attention and ensure the best possible medical outcome. As such, this article will delve deeper into this condition, unravel its complexities, and provide knowledge to navigate pregnancy with confidence and understanding.

Risk factors for placenta accreta

Factors thought to increase an individual’s risk of placenta accreta include:

• Previous history of placenta accreta
• Multiple births 
• Advanced maternal age
• Placental location, for example a low lying placenta
• Uterine abnormalities, such as septate uterus or uterine scarring
• Assisted reproductive technologies including vitro fertilization (IVF)

Several of these are discussed in detail below.

Previous uterine surgeries

When an individual assigned female at birth (AFAB) undergoes uterine surgery, such as a caesarean delivery, scar tissue can form on the uterine wall.¹ This scar tissue may affect the placenta's ability to attach properly during subsequent pregnancies.^2,3 Similarly, other uterine surgeries like myomectomy, which involves the removal of uterine fibroids, can also increase the risk of placenta accreta.⁴

Placenta previa

Placenta previa occurs when the placenta implants low in the uterus and covers part or all of the cervix. This can lead to placenta accreta.⁵ The abnormal positioning of the placenta interferes with its normal attachment and increases the likelihood of complications during childbirth.

Advanced maternal age 

Advanced maternal age is another factor that may contribute to the development of placenta accreta.⁶ As individuals AFAB age, the structural integrity of the uterus may weaken, making it more susceptible to abnormal placental attachment. This risk is further amplified in those who undergo fertility treatments, such as in vitro fertilization (IVF), as these procedures can also impact uterine health.

Uterine abnormalities

Uterine abnormalities, such as a septate uterus or uterine scarring from previous infections or procedures, can create an environment conducive to placenta accreta. These structural irregularities alter the uterine lining's ability to support normal placental attachment, increasing the likelihood of complications during pregnancy.

Symptoms of placenta accreta

The following are symptoms associated with placenta accreta that expectant mothers and healthcare providers should watch out for:

Abnormal vaginal bleeding

One of the hallmark symptoms of placenta accreta is abnormal vaginal bleeding, which may occur during pregnancy or childbirth. This bleeding can be heavier and more prolonged than typical vaginal bleeding experienced during pregnancy, often presenting as bright red blood.⁷ Any unusual or excessive bleeding should prompt immediate medical attention to rule out complications like placenta accreta.

Pelvic pain

Pelvic pain is another common symptom of placenta accreta. It is often described as a persistent, dull ache in the lower abdomen or pelvis. This pain may intensify as the pregnancy progresses, and it can be accompanied by discomfort or pressure in the pelvic region. It's important for individuals to communicate any persistent or severe pelvic pain to their healthcare provider for further evaluation.

Preterm birth

Placenta accreta is often associated with preterm birth (where a baby is born before 37 weeks of gestation).⁸ Preterm birth poses significant risks to the baby's health and development, requiring specialised neonatal care to ensure the best possible outcome. Patients with placenta accreta may be at higher risk of preterm labour and delivery. These patients should be closely monitored throughout their pregnancy.

Failure of the placenta to detach after delivery

In cases of placenta accreta, the placenta may fail to detach from the uterine wall after childbirth, leading to a condition known as retained placenta. This can result in prolonged bleeding and increase the risk of infection and other complications. Healthcare providers will closely monitor the delivery of the placenta, and intervene if necessary to prevent further complications.

Abnormally firm uterus postpartum

Following delivery, the uterus typically contracts to expel the placenta and control bleeding. However, in cases of placenta accreta, the uterus may remain abnormally firm or fail to contract adequately. This can lead to excessive bleeding and other complications, requiring prompt medical intervention to prevent further complications.

Other complications

In addition to the symptoms mentioned above, placenta accreta can present with a range of other complications during delivery, including:⁹

• Excessive bleeding
• Difficulty delivering the placenta
• Increased risk of injury to the uterus

Healthcare providers will closely monitor labour and delivery in placenta accreta patients to manage these potential complications effectively.

FAQs

What is the main cause of placenta accreta?

The main cause of placenta accreta is typically scarring caused by previous uterine surgeries, such as caesarean sections or myomectomy, which can lead to abnormal placental attachment.

What are the symptoms of placenta previa accreta?

Symptoms of placenta accreta may include abnormal vaginal bleeding during pregnancy, pelvic pain, and complications during delivery, such as the failure of the placenta to detach postpartum.

How do you know if you have placenta accreta?

Placenta accreta is diagnosed through imaging studies such as ultrasound and magnetic resonance imaging (MRI), which assess how the placenta is attached to the uterus and evaluate the severity of the condition.

Who gets placenta accreta?

Placenta accreta can affect individuals who have undergone previous uterine surgeries, have placenta previa, or have other risk factors such as advanced maternal age or multiple pregnancies.

What week do you deliver with placenta accreta?

Delivery with placenta accreta is typically planned for 34-36 weeks to reduce the risk of complications, such as bleeding, while allowing for optimal foetal lung maturity.

What are the types of placenta accreta?

Types of placenta accreta include placenta accreta, placenta increta (deeper placental invasion), and placenta percreta (penetration through the uterine wall).

Can you have an abortion with placenta accreta?

In cases of placenta accreta, abortion may carry significant risks due to abnormal placental attachment and increased risk of complications such as bleeding. It is essential to consult with a healthcare provider for personalised guidance and management.

How can you reduce the risk of placenta accreta?

To reduce your risk of placenta accreta, you should avoid unnecessary uterine surgeries, such as elective caesarean sections, and engage with prenatal care. If you do develop symptoms of placenta accreta, early diagnosis and appropriate management of placental abnormalities can help minimise its severity and the risk of complications.

What is the survival rate for placenta accreta?

The survival rate for placenta accreta depends on various factors, including the severity of the condition, timely intervention, and access to specialised care. With proper management, the majority of women with placenta accreta can have successful outcomes.

What is the difference between placenta previa and placenta accreta?

Placenta previa refers to the abnormal positioning of the placenta (i.e. it implants low in the uterus and may cover part or all of the cervix). In placenta accreta, however, the placenta becomes abnormally attached to the uterine wall. This is often associated with previous uterine surgeries or placental abnormalities.

Can placenta accreta be removed manually?

Placenta accreta cannot be manually remedied due to the placenta’s deep attachment to the uterine wall. Surgical intervention, such as a caesarean hysterectomy, is often necessary to remove the uterus and placenta to control bleeding and ensure maternal safety.

What is the mode of delivery for placenta accreta?

The mode of delivery for placenta accreta is typically a planned caesarean section, often performed at 34-36 weeks, to reduce the risk of complications associated with spontaneous labour and vaginal delivery.

Summary

Understanding the causes and symptoms of placenta accreta is vital for expectant mothers and healthcare providers. By recognising the risk factors associated with this condition, such as previous uterine surgeries, placental abnormalities, and maternal age, individuals can take proactive steps to mitigate potential complications and ensure optimal outcomes. Similarly, being aware of the common symptoms of placenta accreta, such as abnormal vaginal bleeding, pelvic pain, and failure of the placenta to detach after delivery, empowers patients to seek medical attention and appropriate management quickly.

Ongoing research and advances in obstetric care hold promise for improving the management and treatment of placenta accreta. By staying informed about the latest developments in this field, healthcare providers can continue to enhance their ability to diagnose, manage, and prevent complications associated with placenta accreta. Ultimately, by raising awareness, fostering collaboration, and prioritising patient-centred care, we can improve outcomes and support the well-being of individuals and families affected by placenta accreta.