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Placenta accreta: a complication to watch out for
Poor implantation of the placenta
The placenta accreta, increta or percreta corresponds to a poor position of the placenta within the uterus, explains Dr Frédéric Sabban, an obstetrician-gynecologist in Paris. Instead of being only attached to the lining of the uterus (or endometrium), the placenta sits too deep. We are talking about placenta accreta when the placenta is inserted lightly into the myometrium (uterine muscle), placenta increta when it is fully inserted into that muscle, or placenta percreta when it “spills over” beyond the myometrium to other organs.
Involved, a scarred uterus
According to Dr Sabban, the main risk factor for this placenta abnormality is having a scarred uterus. It is in fact a uterus which contains one or more scar (s), as a result of an operation. It may just as well be a scar due to an operated uterine anomaly (fibroid, intrauterine endometriosis, etc.) or a scar resulting from a cesarean section. During an abortion or miscarriage, a curettage is often practiced. It involves scraping the surface of the uterus with a surgical instrument to remove the remains of the placenta and this can also cause a scar and then lead to this uterine abnormality.
However, the presence of a placenta accreta or one of its derivatives is relatively rare : it concerns 2 to 3% of women with a scarred uterus. The risk of having this type of placental abnormality is also extremely rare in other women.
When and how is it diagnosed?
There are few symptoms to suggest a placenta accreta. Also, this pathology of the placenta is usually diagnosed late, during the 3rd trimester of pregnancy or at the very end of pregnancy. Most of the time, the diagnosis is made by ultrasound or pelvic MRI. These are generally abnormal bleeding at the end of pregnancy or at the start of labor which suggests the presence of this anomaly.
Childbirth under close medical supervision
If during pregnancy, a placenta accreta does not require special monitoring, it requires special care during childbirth. This is because the main risk from a placenta accreta is hemorrhage from the delivery, which threatens the health of the mother. To minimize complications, the medical team will perform a cesarean section. According to Dr Sabban, a pregnancy with placenta accreta requires a highly medicalized childbirth, so that the patient can be transfused if there is a large bleeding.
Thereafter, doctors will be able to suggest removal of the uterus (hysterectomy) or conservative surgery depending on the patient’s desire for a new pregnancy.