Placenta Accreta Risk Factors And Prevention

Introduction

Are you afraid of developing placenta accreta during pregnancy? Do you need help with what to do? How can you help your child? What will happen during labour? Please calm down. Everything will be fine, and this condition will be under control. Therefore, in this article, you will find everything you need to know about this matter, so let’s start.

Definition of placenta accreta

Placenta accreta is a condition that occurs during pregnancy in which the placenta grows more deeply into the wall of the uterus. As you know, in normal cases, the placenta should detach so easily from the uterus after the baby is born. Still, in our case, the placenta attaches deeply to the wall of the uterus which leads to failure of the placenta to detach and vaginal bleeding. It may end with the need for a hysterectomy(removal of the uterus) to save the mother's life. This condition can be serious and life-threatening, so the best practice is to discover it as soon as possible during pregnancy to save the life of the baby and his mother.¹

Placenta accreta is one of the three variants of morbidly adherent placenta

The other variants are:   

Placenta increta: In this condition, the placenta also attaches deeply into the wall of the uterus but more than the placenta accreta but il does not pass the uterus wall. 

Placenta percreta: This type is considered the most serious condition because the placenta not only attaches deeply to the wall of the uterus but also perforates the wall and invades other organs, such as your bladder or intestines.

Risk factors for placenta accreta

Placenta accreta can occur for no reason, but this is rare. Usually, doctors will find some risk factors that make us know that this pregnant woman has a high risk of developing this disease. 

The following are the risk factors for placenta accreta: 

• Multiple caesarean sections: Women who were exposed to multiple C-sections found that they were at high risk of developing placenta accreta due to scarring of their uterus from the procedures. This is confirmed by research findings²
• Previous womb surgeries: Several types of womb surgeries like myomectomy (fibroid removal), uterine curettage, hysteroscopic surgery, prior endometrial ablation, uterine embolisation, and pelvic irradiation are associated with a high risk of developing placenta accreta. This is also due to tissue removal from the womb and scar formation³
  • Advanced maternal age: Many studies have been done to compare the risk of placenta accreta in younger women and those in advanced age. The conclusion is that women of advanced age have a higher risk of developing placenta accreta when pregnant than younger women⁴ 

• Placenta praevia

This condition occurs when the placenta blocks your cervix. When associated with placenta accreta it becomes more difficult and more serious and leads to serious outcomes for you and your baby.

There is evidence that the presence of placenta previa and a history of previous c-sections with advanced maternal age all increase the risk of developing placenta accreta. ⁵

• Assisted reproductive technology (ART)

This procedure helps you to get pregnant, as it is defined as any fertility-related treatment in which eggs or embryos are manipulated outside the body.  In general, ART procedures involve surgically removing eggs from a woman's ovaries, combining them with sperm in the laboratory, and returning them to the woman's body.

There is research evidence that pregnancy after ART is associated with a significantly increased risk of abnormal placental attachment.⁶

• Maternal smoking

There is evidence that smoking can be a risk factor for increasing the incidence of placenta accreta.⁷

How is placenta accreta diagnosed and the importance of that?

In the past, the presence of placenta accreta lead always to hysterectomy(removal of the womb) as it caused severe bleeding and was not discovered until the time of labour. The womb is usually removed to save the mother’s life doctors.⁸

In recent times, advances have been made in diagnosis before delivery and in surgical techniques related to placenta accreta.  Diagnosing placenta accreta before delivery enables treatment planning.  This enables better control of bleeding and offers a greater possibility of preserving life, the womb, and fertility.⁸

Ultrasound is one of the diagnostic methods. If you become pregnant and have one or all of the risk factors you should do an ultrasound from the beginning of the pregnancy to date the pregnancy.⁸

In the latter part of pregnancy, a more detailed evaluation of the condition of the placenta is needed, so a special ultrasound called the Doppler ultrasound is needed to diagnose placenta accreta.

Magnetic nuclear resonance (MRI) is another imaging modality which is used to diagnose placental accreta between 24 and 30 weeks.⁸

Prevention strategies

The main point in preventing placenta accreta is to decrease the number of cesarean sections by doing it only when needed.

if there are any of the risk factors mentioned above, what can be done is to diagnose and correctly manage the condition when it happens 

Early diagnosis of placenta accreta, adequate planning of surgical intervention, and the use of effective surgical modalities to control intraoperative bleeding offer a greater possibility of preserving life, the uterus, and fertility.⁸

Strategies for the prevention of placenta accreta

Prepregnancy counselling

Prepregnancy counselling is so important, especially for women who have a high risk of developing placenta accreta due to the presence of previous C-sections or uterine surgeries. 

it is necessary to tell them the predicted outcomes of being pregnant again and the risk of placenta accreta.

Also, they should be encouraged to do optimal birth spacing. They may be advised not to be pregnant again if they have a history of multiple cesarean sections.⁸

Antenatal care

Prenatal care is very important for any pregnant woman to help early detection of placenta accreta through ultrasound imaging. This would allow for the monitoring of her high-risk pregnancy closely to detect any problems on time. This would give room for early intervention.⁸

Reducing the rate of caesarean section 

Nowadays, there is an increase in the number of caesarean sections. Due to this the number of cases with placenta accreta and placenta previa has become high.  Doctors must make C-sections the last option for delivery to prevent the formation of uterine scar which will lead to the development of placenta accreta ⁹

Planned hysterectomy

Consent for a hysterectomy should be obtained before performing a cesarean section for a patient with placenta accreta. This enables timely intervention if complications arise.⁸

Multidisciplinary team approach

The management of placenta accreta must be outlined in a preoperative plan and executed by a multidisciplinary team to ensure collaborative planning and optimize outcomes. Involving specialists from various fields is crucial, as this condition can impact organs beyond just the uterus, particularly in cases of placenta percreta. Therefore, the surgical institution should be fully prepared with all necessary resources for the patient.

Ideally, the team should include anaesthetists, obstetricians, gynaecological surgeons, neonatologists, haematologists, blood bank staff, interventional radiologists, intensivists, and specialized nursing teams.^8,9

Summary

In conclusion, we discussed the potential risk factors contributing to the development of placenta accreta. We outlined preventive strategies that can help save the lives of pregnant women and help in the early detection of this condition. But my advice to you is to do birth control if you have multiple cesarean sections so you don't expose yourself to the risk of placenta accreta if you become pregnant again. If you have been diagnosed with placenta accreta during your pregnancy, it is crucial to continue regular follow-ups with your doctor and adhere to their instructions.​​ Early detection and ongoing monitoring throughout pregnancy until labour are crucial for ensuring the safety of both you and your baby.      

FAQs

What is the risk of death with placenta accreta?

The risk of death in this condition is serious, with mortality as high as 7%. The causes that lead to death are not defined and need more studies to confirm that, but there is research evidence that lack of experience and inadequate surgical technique are the most frequent problems associated with maternal deaths in placenta accreta. ¹⁰

How long can you carry a baby with placenta accreta?

Babies of pregnant women with placenta accreta may be born prematurely especially if it is associated with placenta praevia,. ¹¹

What are the complications associated with placenta accreta?

The most common maternal complication associated with the placenta accreta is postpartum haemorrhage. This can be associated with hypotension(low blood pressure), multiple blood transfusions, post-resuscitation fluid overload, and abnormalities in your blood clotting. ³

Is IVF a risk factor for placenta accreta?

Yes, IVF (in vitro fertilisation) is considered a risk factor for placenta accreta but still, the reason and the mechanism for that is unclear. However, many studies confirm that Women with an IVF pregnancy carry an increased risk of placenta accreta compared with other pregnant women.¹²