Hello,

I have been pregnant twice and had both my children at planned, CPM-attended homebirths after healthy, normal pregnancies.  After my second birth, I retained parts of the placenta, hemorraged, and required an emergency transfer to the hospital for attempted manual extraction then a D&C followed by blood transfusions.   At a post-partum check, my midwife told me that I had retained the placenta because of placenta accreta. 

I am having a difficult time finding consistent information on future risks.  Some sources say that accreta rarely reoccurs; others say that reoccurence of accreta (or increta or percreta) is common. 

Where can I find reliable information on accreta and future risks when deciding whether to have a third baby and if so, whether another homebirth would be safe for me?

Thank you!

Jessica

Here’s what I could find in my files: Placenta accreta in the absence of a predisposing factor such as uterine scar from a prior cesarean is vanishingly rare. Miller found that in women with no prior cesareans, 1 in 10,000 (16 out of 138,000 women) had a placenta accreta. I’m sorry that you were the rare unlucky one. It does, look, though, as if having had placenta accreta once puts you at somewhat higher risk to have it happen again. Gielchinsky reported an overall rate of 0.9% (310 among 34,500 deliveries), which included women with prior cesareans. However, 49 women of the 310 had a repeat accreta, of whom 4 women had a repeat cesarean. Those 49 women represented 16% of women with placenta accretas.

Gielchinsky Y, Rojansky N, Fasouliotis SJ, et al. Placenta accreta--summary of 10 years: a survey of 310 cases. Placenta 2002;23(2-3):210-4.

Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997;177(1):210-4.

I hope this gives you somewhat more information on which to base your decision.

-- Henci

Thank you!  I plan to look at those sources.

May I ask a follow-up question or two?

1. If PA is that rare, I'm wondering if my midwife may have misdiagnosed the reason for the retention.  She was not privy to the surgical records as far as I know.  What is the best way to re-diagnose a condition like this?

2. Although I had no cesarean scar or any prior D&Cs, I did become pregnant on only my second menstrual cycle after the birth of my first child (at 27 months post partum, thanks to breastfeeding).  Could my risk of PA have been increased if my luteal phase and endometrium were not regular yet?

Thank you again,

Jessica

Apologies, but I don't have any information that could help you with either question. For the first one, at least, I have a suggestion: Your midwife may not be privy to your surgical records, but you are. Every person is entitled to his or her medical records. You may wish to get a copy of yours and review them with an obstetrician whose opinion you trust. You might ask your midwife whom she recommends.

-- Henci