Also called: Placenta Accreta; Placenta Increta; Placenta Percreta
Placenta accreta spectrum is a rare but serious condition that happens when the placenta abnormally attaches to the uterine wall during pregnancy. After the baby is delivered, the placenta does not separate from the uterus as it should. This can cause life-threatening bleeding if it isn’t properly treated. Placenta accreta spectrum occurs in less than 1% of all pregnancies.
The UAMS Approach to Treating Placenta Accreta Spectrum
As of February 2020, UAMS is a recognized Placenta Accreta Center of Excellence according to the Maternal Safety Foundation. We are the only program in Arkansas to offer specialized treatment and management of placenta accreta spectrum. The UAMS Placenta Accreta Spectrum Care Team is a diverse team of doctors led by experienced maternal-fetal medicine specialists who work with obstetrical anesthesiologists, acute care surgeons, and neonatologists to provide the best care for women with disorders of the placenta accreta spectrum. We may also involve other sub-specialists such as urologists, gynecologic oncologists, or vascular surgeons.
Our approach includes:
- Consultation with one of the maternal-fetal medicine doctors who specializes in the management and treatment of placenta accreta spectrum.
- Ultrasound evaluation and MRI if indicated.
- Consultation with the obstetric anesthesiology team
- Consultation with the neonatology team. Because most of these babies are born before their due date, they often have to spend time in the NICU.
- Plan for a carefully timed, controlled cesarean delivery.
- Steroid administration before delivery to help with the baby’s lung development.
- Resources available at the time of surgery:
- Largest blood bank in the state
- Medical resources available at the time of surgery like REBOA and Cell Saver
- Anesthesiology staff specially trained in obstetrics
- Surgical specialists on-call 24/7
More About Placenta Accreta Spectrum
Placenta accreta spectrum is defined by how deeply the placenta is attached to the uterus. It includes:
- Placenta accreta – Placenta grows into the uterine lining.
- Placenta increta – Placenta grows into the muscular wall of the uterus.
- Placenta percreta – Placenta grows through the muscular wall of the uterus and can sometimes become attached to nearby structures, such as the bowel, bladder or blood vessels.
Who is at risk for placenta accreta?
- Patients with placenta previa, which is where a portion of the placenta covers the cervix
- Those with a history of c-section (risk increases with the number of prior c-sections)
- Those with a history of a D&C, ablation or other uterine surgeries
- Age 35 or older
- Patients with a history of smoking
- Patients who have had infertility treatment
- Patients with a history of uterine infections
Diagnosis of Placenta Accreta
Placenta accreta is most commonly diagnosed through an ultrasound. MRI is sometimes used, mostly to help with delivery planning. Patients with a history of previous c-section deliveries, especially those with a placenta previa, should be carefully screened.
About a Delivery Complicated by Placenta Accreta Spectrum
- Delivery is typically planned for 4-6 weeks before the due date
- A hysterectomy is performed
- The hospital stay is usually longer (4-5 days as opposed to 2)
- More blood loss is usually encountered and often requires transfusion of blood products
- A vertical or “up and down” incision is used that typically extends above the belly button rather than a “bikini cut”
- ICU stay for the mother and NICU stay for the baby are often required after delivery
- The risk of damage to bowel, bladder and surrounding vessels is higher
If the placenta does not separate from the uterus at the time of delivery, a hysterectomy is often required in order to prevent severe maternal blood loss. Because these surgeries are so high-risk, it is important to seek care at a hospital with a designated team that performs these procedures often.