In many cases, placenta accreta may cause no symptoms. However, certain percentage of women may experience vaginal bleeding during the third trimester. Such emergency situation calls for immediate hospitalization followed by prompt initiation of treatment. Caesarean section for delivery of the baby and hysterectomy is often the treatment of choice in such cases.

• Surgical Procedure

  In such a condition, it becomes difficult to separate placenta from the uterine wall which calls for an emergency surgical procedure. [symptoma.com]

  We then offered 2 choices for patients who had preferred conservative treatment, leaving the placenta in situ as is the classical procedure, or our surgical procedure. [ncbi.nlm.nih.gov]

• Sepsis

  Hysterectomy was planned 3 months after conservative treatment because of sepsis attributed to uterine retention. (Hysterotomy was first realized.)-?? Uterine conservation. [ncbi.nlm.nih.gov]

  The woman needs to be emphasised upon need for close follow up and risk of haemorrhage and sepsis till complete resorption of placenta occurs. References Sajjad N, Khandwala K, Memon WA, Shahid J, Zafar B. [ijrcog.org]

  Co-author Dena Goffman, MD, assistant professor of obstetrics and gynecology at the same institution, added, "Maternal hemorrhage is always among the top four causes of maternal mortality in the United States, along with pulmonary emboli, sepsis and hypertensive [medpagetoday.com]

• Falling

  The wall of the uterus is almost fully penetrated but still falls short of attaching to the muscle. Increta is the second most common type of abnormal placenta attachment accounting for 15% of cases. [birthinjuryhelpcenter.org]

  Placenta accreta falls within a spectrum of three closely related conditions. The main distinguishing feature is how extensively your placenta is attached. The three degrees of placental attachment are: Placenta accreta. [webmd.com]

  But a third baby could be very risky for the reality TV star, who revealed in an episode last fall that she had experienced a serious complication involving her placenta during both of her first two pregnancies. [ 9 Uncommon Conditions That Pregnancy [livescience.com]

  An article featured in the Fall 2013 edition of Stanford Medicine, sheds light on the severity and daunting nature of this disorder and its treatment. [stanfordbloodcenter.org]

• Fishing

  READ MORE Mercury Levels in Fish Many people enjoy eating fish and women who are pregnant are no exception. This article covers the mercury levels in various types of fish. [americanpregnancy.org]

  The surrogate is likely to have stipulations written into her contract, such as avoiding smoking, drinking, drugs, raw fish and other substances which can affect the development of the foetus. [independent.co.uk]

  They allegedly also have certain stipulations, such as a ban on smoking, drinking, drugs, hot tubs, raw fish, hair dye and other regulations for the duration of the pregnancy. [marieclaire.co.uk]

  Fear not, though, if you do need this second procedure it's a completely different kettle of fish to the initial operation. [mumroll.blogspot.com]

• Inflammation

  The underlying molecular biology of PAS is a complex process that requires further research; for ease, we have divided these processes into angiogenesis, proliferation, and inflammation/invasion. [ncbi.nlm.nih.gov]

  As previously discussed, PAS is often associated with a chronic basal inflammation. [hindawi.com]

• Placental Disorder

  Disorders, Beth Israel Deaconess Medical Center, Boston, USA. 4 Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. [email protected] 5 New England Center for Placental [ncbi.nlm.nih.gov]

  ( O44.- ) placental polyp ( O90.89 ) placentitis ( O41.14- ) premature separation of placenta [abruptio placentae] ( O45.- ) Placental disorders O43.2 ICD-10-CM Diagnosis Code O43.2 Morbidly adherent placenta 2016 2017 2018 2019 Non-Billable/Non-Specific [icd10data.com]

• Cesarean Section

  Women who labor after a prior cesarean section are at risk for uterine rupture. [brighamandwomens.org]

  With a placenta previa and one previous cesarean section, the risk of placenta accreta was 24%; this risk continued to increase to 67% (two of three) with a placenta previa and four or more cesarean sections. [ncbi.nlm.nih.gov]

• Vaginal Bleeding

  Complications Placenta accreta can cause: Heavy vaginal bleeding: Placenta accreta poses a bigger risk of severe vaginal bleeding (haemorrhage) post-delivery. The bleeding may cause a severe condition that prevents the blood from clotting normally. [healthlibrary.askapollo.com]

  Vaginal bleeding is experienced in the third trimester which requires immediate attention and immediate treatment to avoid unnecessary complications. [symptoma.com]

  OBJECTIVE: To evaluate the incidence of vaginal bleeding in women with placenta accreta according to gestational age at delivery. [ncbi.nlm.nih.gov]

  And vaginal bleeding during the third trimester can be a warning sign. If you have vaginal bleeding during your third trimester, contact your healthcare provider immediately. If the bleeding is severe, call 911 or go to the emergency room. [babycenter.com]

  Complications Placenta accreta can cause: Heavy vaginal bleeding. Placenta accreta poses a major risk of severe vaginal bleeding (hemorrhage) after delivery. [mayoclinic.org]

Women who have undergone caesarean section in the past or have suffered from placenta previa or any uterine surgery, tests to determine placenta accreta for the current pregnancy may be carried out. The following diagnostic procedures are done to detect this condition:

• Blood work to determine the levels of alpha fetoprotein. Rise in levels of alpha fetoprotein is a strong indicator for placenta accreta.
• Imaging studies such as ultrasound, MRI and CT scan of the uterus is done to evaluate the positioning of the placenta [6]. If placenta accreta is present, the ultrasound examination would reveal a “moth-eaten” or “Swiss cheese” appearance to the placenta. The use of ultrasound data with a high suspicion of placenta accreta, history of previous caesarean sections and presence of placenta previa plotted in mathematical model may prove to be more effective in predicting placenta accreta preoperatively [7]. The antenatal diagnosis of placenta accreta may prompt the attending physician to prepare fresh whole blood before delivery to prevent lethal blood loss in patients [8].

Once placenta accreta is diagnosed during pregnancy, a treatment plan ensuring safe delivery of the baby is chalked out. In case of severe placenta accreta a caesarean section is done for delivery of the baby followed by hysterectomy to avoid complications to set in [9]. These placenta accreta cases are most common among patients with previous caesarean section scarring [10]. In such cases, the uterus is removed to prevent further complications to the mother. The procedures should be carried out in hospitals that have adequate facilities to handle severe complications.

A test known as maturity amniocentesis is done is cases when premature delivery is planned. This test measures the maturity of the heart and lungs of the baby so that the delivery can be done prior to completion of 38 weeks of gestation.

In rare cases the uterus is not removed, basically when the woman plans to get pregnant in future. However, such a decision may pose several health risks to the mother and the risk is seldom taken. It also gets worth mentioning that there is dearth of research studies that suggest an association between complications in future pregnancies if hysterectomy is avoided. It is therefore suggested that, women who wish to preserve their fertility should discuss the pros and cons with their health care provider.

The prognosis of placenta accreta is largely dependent on the time of diagnosis. If it has been diagnosed during pregnancy, then there is sufficient amount of time for effective management of the condition and counseling of the mother. However, if it is diagnosed during delivery, then women undergo caesarean section to deliver the baby followed by hysterectomy.

Appropriate planning can be made and emergency situation avoided if the diagnosis is made during pregnancy. This can also avoid complications from developing and allow for a better prognosis. Mothers who deliver in a tertiary hospital with a multidisciplinary team on standby may have a good prognosis [5].

Complications of placenta accreta include the following conditions:

• Heavy vaginal bleeding is one of the major life threatening complications of placenta accreta. In this, there is heavy blood loss due to disseminated intravascular coagulopathy. 
• Lung failure
• Kidney failure
• Premature delivery may be required as the labor begins early in such cases. In addition, if women experience bleeding during pregnancy, then the child may have to be delivered before time.

Placenta accreta occurs due to development of abnormalities in the lining of the uterine wall. This can be a result of scarring that develops due to previous surgical procedures concerning the uterus [2]. In addition, it is also thought that caesarean section is one of the major causative factors for placenta accreta [3]. A caesarean section causes scarring in the lining of the uterus especially those with retained uterine sutures from the previous operations leading to development of such a condition [4].

Research has pointed towards the fact that the increase in the rate of caesarean section deliveries also increases the risk of developing placenta accreta. It has also been estimated that placenta accreta occurred in about 1 in 533 pregnancies in the years 1982 to 2002. Statistics indicate a significant rise in the incidence of placenta accreta in the past few decades.

Under normal circumstances, the placenta attaches to the wall of the uterus for providing nutrients and oxygen to the developing fetus. During delivery, the placenta detaches itself from the uterine wall. In the condition of placenta accreta, either a part of the placenta or the entire placenta invades the uterine wall and grows deep inside it. This causes severe blood loss during the third trimester and even during delivery. Such a condition can also develop due to malformation or absent decidua (mucous membrane that lines the uterus).

There is no way to prevent placenta accreta. However, complications can be prevented if the condition is diagnosed during pregnancy so that an effective treatment plan can be carried out.

Placenta accreta is potentially a life threatening condition that develops when the placenta invades deep into the uterine wall [1]. In such a condition, it becomes difficult to separate placenta from the uterine wall which calls for an emergency surgical procedure.

Placenta accreta is becoming an increasingly common complication of pregnancy which can cause life threatening hemorrhage if hysterectomy is not done on time. When such a condition develops, the woman is taken for caesarean section followed by surgical removal of the uterus.

Definition

Placenta accreta is a condition characterized by abnormal attachment of the placenta to the uterus. It is a high risk obstetric condition, wherein the placenta invades deep into the uterine wall. Such a condition calls for severe complications to set in. With the increasing incidence of caesarean section, the incidence of placenta accreta is also increasing.

Cause

Scarring in the lining of the uterus is the major factor identified behind the development of placenta accreta. Caesarean section and other surgical procedures of the uterus are some of the risk factors for placenta accreta.

Symptoms

Heavy bleeding is the significant symptom of placenta accreta. In many cases, the condition produces no symptoms. Vaginal bleeding is experienced in the third trimester which requires immediate attention and immediate treatment to avoid unnecessary complications.

Diagnosis

Diagnosis of placenta accreta is done using imaging studies such as ultrasound, MRI and CT scan of the uterus. Ultrasound may reveal the actual features of the placenta which would help diagnose the condition. A blood test that reveals elevated levels of alpha fetoprotein is indicative of placenta accreta.

Treatment

Treatment depends on the severity of the condition. In many cases, premature delivery is done to protect both the baby and the mother from serious complications. Following this a hysterectomy would also be required.

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3. Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births.Am J Obstet Gynecol. 2013; 208(3):219.e1-7 
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8. Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand. 2011; 90(10):1140-6 
9. Tsankova M, Marinov B, Bozhilov D, Pirnareva E. Placenta accreta--prenatal diagnosis, treatment. Akush Ginekol (Sofiia). 2013; 52(2):48-53 
10. Higgins MF, Monteith C, Foley M, O'Herlihy C. Real increasing incidence of hysterectomy for placenta accreta following previous caesarean section. Eur J Obstet Gynecol Reprod Biol. 2013; 171(1):54-6