Placenta accreta is a serious complication of pregnancy in which the placenta adheres abnormally to the uterus.
The incidence of placenta accreta has increased in recent years since several of its risk factors have also increased (previous uterine surgeries, previous deliveries, being over 35 years old…).
A normal delivery has three phases:
- Dilation: phase in which the cervix is erased and dilated with contractions, until the neck is fully dilated, this is 10 cm.
- Expulsive: phase in which the fetal head descends into the pelvis until the fetus has completely emerged.
- Delivery: The fetus has already delivered and the placenta and membranes are shed and expelled.
Patients with a placenta accreta have a pathological phase of delivery as the placenta cannot be delivered in the normal way. Part or all of the placenta remains attached to the wall of the uterus and causes excessive bleeding.
Placenta accreta symptoms
The accreta placenta usually gives no symptoms until the period of birth of childbirth, although sometimes ultrasound may be some suspicion. Sometimes an MRI can be performed to better visualize the insertion of the placenta if there are doubts by ultrasound.
The risk factors are:
- Previous uterine surgery: previous cesarean section, myomectomy….
- Placenta previa: the placenta is in front of the cervix and prevents the passage of the fetal head.
- Age of the mother: over 35 years the placenta accreta is more frequent.
- Previous deliveries: the risk of accreta placenta increases proportionally to the number of previous deliveries.
Complications of the placenta accreta
Placenta accreta has traditionally been a risk factor for maternal mortality, but in recent decades mortality due to placenta accreta has decreased from 9.5% to less than 1%.
The most severe grade of placenta accreta is placenta percreta in which the placental tissue completely crosses the wall of the uterus and can eventually invade neighboring organs such as the urinary bladder. In these cases, in addition to a risk of mortality over 7%.
Excessive bleeding from a poorly inserted placenta often leads to the need for blood transfusion. If the placenta is percrete, it may force surgery is that the affected organs such as the urinary bladder must be reconstructed, with the consequent possible permanent involvement of these organs.
The importance of early diagnosis
The prognosis of placenta accreta depends on several factors, but a very important one is the time of diagnosis. The patient with a suspected placenta accreta during pregnancy is very different and surgery can be scheduled with a multidisciplinary team and with blood in reserve in case it is necessary, than the patient who has a normal delivery and at the time of waiting for delivery it causes significant bleeding and urgent surgery is required.
How to proceed then…
The most common is having to perform an urgent hysterectomy, that is, removing the womb to avoid massive bleeding. In this case, the ovaries would be preserved so that the patient would not be menopausal but she would not have her period as she did not have a womb nor could she bear more children.
Sometimes it is possible to remove the entire placenta with a uterine curettage with a large curettage, which is an instrument shaped like an empty spoon through the center and at the edges scratches the surface against which it is scratched.
But the risk of this treatment is that the abrasion on the inner face of the womb produces an even more abundant bleeding or that an injury occurs that crosses the entire thickness of the wall of the uterus, you have to be very careful with a curettage in an accreta placenta.
Finally, and in very few cases, conservative treatment is achieved by allowing the placenta to dissolve over time, especially in cases of focal accreta, that is, of a part and not of the whole of the placenta.
The risk of conservative treatment is the possibility of heavy vaginal bleeding, risk of infection of the remaining tissue and the womb, risk of tissue embolism or a blood clot, and risk of having to perform a hysterectomy later due to failure of the absorption of the remaining placental tissue.
In cases of conservative treatment, an antibiotic regimen of at least 10-14 days should be left and weekly controls should be carried out.
What you should know…
- In childbirth, the placenta cannot be delivered in the normal way. Part or all of the placenta remains attached to the wall of the uterus and causes excessive bleeding.
- The incidence of placenta accreta has increased in recent years since several of its risk factors have also increased (previous uterine surgeries, previous deliveries, being over 35 years old…)
- The prognosis of placenta accreta depends on several factors, but a very important one is the time of diagnosis.