What Is Placenta Accreta Spectrum?
The placenta is an organ that develops in the uterus during pregnancy to provide oxygen and nutrients to your baby and to remove waste products from the baby’s blood. Normally, the placenta attaches to the wall of the uterus during pregnancy and is delivered after you have your baby.
However, about one in 500 women develop a condition called placenta accreta spectrum (or placenta accreta), which means that the placenta has grown deeper than it should, into the lining or wall of the uterus, and can’t detach after childbirth.
Types of Placenta Accreta Spectrum
There are three types of placenta accreta spectrum, determined by how deep the placenta has grown:
- Placenta accreta—the placenta grows into the lining of the uterus. This is the most common type, occurring in 75 percent of cases.
- Placenta increta—the placenta grows into the wall of the uterus.
- Placenta percreta—the placenta grows through the wall of the uterus, at times into nearby organs such as the bladder or colon.
This condition can be very serious and may lead to hemorrhaging, organ failure, acute respiratory distress syndrome, and even death. Providers at University of Utah Health are specifically trained to care for patients with placenta accreta.
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Who Is at Risk of Placenta Accreta?
If you have had a cesarean delivery (C-section) before, you have a higher risk of developing placenta accreta. This risk increases with each additional C-section you have, especially if you also have a placenta previa (when the placenta covers the opening in the mother’s cervix).
You may have a higher risk of developing placenta accreta if you:
- have had multiple past pregnancies,
- have had a C-section,
- have a placenta previa,
- have had surgery on or around your uterus, or
- have Asherman’s syndrome.
We recommend that all women with placenta previa who have had a cesarean section have a specialized ultrasound and consultation to evaluate the risk of placenta accreta.
Signs & Symptoms of Placenta Accreta
Typically, women with placenta accreta do not have any signs or symptoms, although you might experience bleeding during the second half of pregnancy. If you have had multiple C-sections or surgery on or around your uterus, you should see a doctor as early as possible to make sure you and your baby are safe.
Care During Pregnancy & Delivery
If you are diagnosed with placenta accreta, our team of doctors, research coordinators, fellows, residents, nurses, and scientists will monitor you closely during your pregnancy and delivery. Your case will be reviewed at a monthly placenta accreta conference, where providers will discuss your care and determine next steps.
Risk of Early Labor
Women with placenta accreta are at risk of going into labor early, which can cause severe bleeding and is very dangerous if you're not able to quickly get care from experienced specialists and surgeons. We recommend planning to have your delivery between 34 and 36 weeks (a month or more before your due date) to avoid labor and bleeding, while still giving your baby enough time to be healthy at birth.
Precautions During Pregnancy
Because you will most likely have your baby before your due date, you will be given steroid shots during your pregnancy to help prepare your baby for the outside world. This can help decrease the chance of breathing problems and other issues in premature babies.
In the third trimester, you may want to consider moving closer to the hospital if you live more than 30-40 minutes away, in order to avoid being too far away when labor or bleeding start.
Delivery: C-Section & Hysterectomy
You will probably not be able to have a vaginal delivery. Most likely you'll have a C-section to deliver your baby. Most patients will need to have a total or partial hysterectomy immediately following delivery, with the placenta left inside the uterus when it is removed to avoid bleeding.
In rare cases it is possible to safely avoid a hysterectomy by removing most of the placenta and leaving the portion attached to the uterus, but this option can lead to complications after surgery and in future pregnancies.
Your Delivery Team
On the day of delivery, we will have several teams of specialists on standby to ensure you have a healthy birth and surgery, including the following:
Recovery is different for every patient. You’ll most likely stay in the hospital for three to five nights after delivery, similar to recovery after a C-section. Some women will need to stay in the intensive care unit for a day or two to help them recover from blood loss.
You’ll also be given pain medicine through an IV while in the hospital and oral pain medicine to help manage your pain after you return home.
About one to two weeks after delivery, you'll meet with your doctor to make sure that your recovery is going well and that there are no complications. You'll have additional follow-up appointments as needed. If you had a complicated delivery, you may need see your doctor more frequently during your recovery.