Placenta accreta is a condition where the placenta attaches too deeply to the uterine wall, causing difficulty in delivering the placenta after birth. It can lead to severe bleeding, hysterectomy, or death. Risk factors include placenta previa and history of cesarean section. There are three forms of placenta accreta, with the most severe form, placenta percreta, causing damage to other organs. Treatment may involve a C-section, hysterectomy, or surgical removal of the placenta.
Placenta accreta is a medical condition in which a pregnant woman’s placenta attaches too deeply and tightly to her uterine wall. The placenta is a plate-like organ that sits against the inner wall of the uterus and carries nutrients and oxygen from a mother to a developing fetus via the umbilical cord. Normally, the placenta begins to develop at the time of conception, attaches itself to the endometrium, or innermost layer, of the uterus, and is finally pushed out of the body during delivery. Women who develop placenta accreta, however, often have difficulty delivering the placenta after the baby is born and may need surgery to remove the placenta. The condition can cause the patient to bleed severely, require a hysterectomy, or even die in extreme cases.
The uterus, or womb, is a muscular female reproductive organ with four layers; the peritoneum, the perimetrium, the myometrium and the endometrium. In a healthy reproductive process, the fertilized egg attaches itself to the endometrium, and both the fetus and the placenta develop from the egg. When the baby is born, the muscle layer of the uterus, the myometrium, contracts to help push the baby out of the body. After the baby is born, the mother’s body will push out the bleeding lining and the placenta, which will still be attached to the baby via the umbilical cord if it hasn’t already been cut.
For unknown reasons, about one in 25,000 pregnant women develops placenta accreta. Because placenta accreta is difficult to diagnose or see on an ultrasound, this condition usually goes undetected until delivery. Risk factors include placenta previa and history of cesarean section. Placenta previa occurs when the placenta is attached to the bottom of the uterus, instead of the top. This condition can cause severe vaginal bleeding before or during delivery as the cervix, the opening in the lower part of the uterus, expands to allow the baby to be expelled. Placenta previa is usually diagnosed in time for taking necessary precautions, including preparing for the increased risk of placenta accreta.
There are three forms of placenta accreta, classified according to the depth of invasion of the uterine wall. If the condition is referred to simply as placenta accreta, it implies the less severe form, in which the placenta is tied too deeply in the endometrium, but has not invaded the myometrium. This is the most common of the three, comprising about 75% of all cases of placenta accreta. The second most common form, placenta increta, penetrates more deeply into the endometrium, invading the smooth muscle of the uterus. The third rarest type is placenta percreta, which occurs when the placenta passes through all layers of the uterus, sometimes binding itself to another organ and causing great danger to the patient.
Complications of placenta accreta include severe vaginal bleeding, uterine rupture, and premature birth. In the case of placenta percreta, the condition can damage not only the uterus but other organs, such as the bladder, ureters and kidneys. A doctor will generally recommend a C-section to remove the baby and placenta from the mother, with minimal harm to the mother or baby. Because it is dangerous to give birth prematurely, doctors will help patients carry the baby as long as possible before scheduling the delivery.
Doctors may also recommend a hysterectomy, the surgical removal of the uterus, to prevent the possibility of serious bleeding. If the uterus is removed, the mother will no longer be able to conceive, but the operation will greatly increase her chances of survival. In some patients, placenta accreta may be mild enough for a doctor to surgically remove the placenta and stem blood flow while keeping the uterus intact. However, hysterectomy is usually the safer choice, especially since most cases occur during delivery, when rapid intervention is needed.
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