October is ICAN Accreta Awareness Month, an event created by the International Cesarean Awareness Network (ICAN) to bring attention to the condition of "placenta accreta," which is when the placenta attaches too deeply into the wall of your uterus. In a normally developing pregnancy, your baby's placenta attaches to the uterus and detaches normally from the uterus shortly after birth. In placenta accreta, the placenta attaches too deeply into the uterus but does not penetrate the uterine muscle. There is also placenta increta where the placenta attaches too deeply and penetrates the uterine muscle. Placenta percreta is where the placenta attaches too deeply, penetrates through the uterine muscle and wall, and attaches to another organ, like the bladder. The serious and life-threatening complications from accreta occur after birth when the placenta cannot detach from the uterus and causes bleeding.
ICAN aims to make people aware of this condition because there is a 7% rate of death due to massive blood loss, and because the rate of placenta accreta is on the rise as it is more commonly seen in parents with a previous cesarean birth. ICAN wants to spread the message of awareness because while many parents are counseled about the risk of uterine rupture when attempting a VBAC, few are made aware of the risks of accreta. Additionally, few parents know that placenta accreta is a potential future complication caused by cesarean. Whether you're pregnant, trying to get pregnant, or planning on being pregnant in the future, it's important to know the facts about placenta accreta.
Facts You Should Know About Placenta Accreta
What Causes Placenta Accreta
While exact causes remain unknown, we do know certain risk factors:
- Past uterine surgery, including c-section, fibroids removal, DNC
- Placenta previa (where the placenta grows partially or fully over the opening of the cervix)
- May occur without history of surgery (though less common)
How Is Placenta Accreta Diagnosed & What Are the Symptoms?
Often, there are no symptoms of placenta accreta until after birth when complications arise when the placenta tries to detach. Third trimester bleeding also can be a symptom of placenta accreta. An ultrasound may be able to detect placental attachment abnormalities.
How Is Placenta Accreta Treated
Often, the treatment for placenta accreta is to perform a cesarean and remove the uterus along with the placenta (a hysterectomy). There is a more rare and risky procedure in which a portion of the placenta is left in the uterus to try and dissolve on its own, but this procedure carries additional and serious risks. It's important to talk to your doctor about your options.
What Are the Risks of Placenta Accreta
Risks of placenta accreta are many. The following list is excerpted from a post this week on Science & Sensibility:
- massive obstetric hemorrhage
- disseminated intravascular coagulopathy
- need for hysterectomy
- surgical injury to the ureters, bladder, bowel, or neurovascular structures
- adult respiratory distress syndrome
- acute transfusion reaction
- electrolyte imbalance
- renal failure
- Average blood loss at delivery in women with placenta accreta is 3,000–5,000 mL
- 90% of patients with placenta accreta require blood transfusion
- 40% require more than 10 units of packed red blood cells
- Maternal mortality with placenta accreta can be as high as 7%
Can Placenta Accreta Be Prevented?
Placenta accreta cannot be prevented at this time. Avoiding uterine surgery (when possible) will lower your risk.
Learn more about placenta accreta and hear first-hand stories from families this month on the ICAN Facebook page.