In placenta accreta, the placenta is fused to the muscle of the uterus. As a result, severe bleeding occurs during vaginal birth, necessitating incisional delivery. Doctors suspect scar tissue in the uterus as the cause of the phenomenon.
What is placenta accreta ?
In placenta accreta, the muscles of the uterus are fused to the placenta. Thus, after the birth process, there is no natural detachment of the placenta. Usually, therefore, heavy bleeding is associated with childbirth. Around one in 2500 pregnant women currently suffers from placenta accreta. This condition is also known as abnormally adherent placenta and can cause severe complications during birth. Several forms of placenta accreta are distinguished. The most severe form is placenta increta or placenta percreta. One of the mildest forms is the special form of placenta adhaerens. Suspicion of placenta accreta usually arises long before delivery, so the pregnant woman can either agree in advance to an incisional delivery or request a vaginal delivery with appropriate preparations despite the risk of complications.
Causes
In placenta accreta, the endometrium is absent or at least the mucosa is not well developed. Thus, the trophoblasts grow unimpeded to the muscles of the uterus. In some cases, the trophoblasts even grow into the muscle of the uterus as well. Ingrown trophoblasts correspond to a severe placenta accreta. Only ingrown trophoblasts, on the other hand, are found in the milder forms. Scar tissue on the uterus can also cause placenta accreta. In this case, the primary cause may be Asherman’s syndrome, for example, which is usually preceded by uterine surgery or incisional delivery. Experts therefore believe that the increasing trend toward cesarean delivery in the 21st century is the main cause of the increased placenta accreta rate. Myoma removal or curettage also sometimes causes Asherman syndrome. At ages older than 35 years, the overall risk of complications for pregnancies increases. The risk of placenta accreta also increases with the overall risk of complications.
Symptoms, complaints, and signs
Throughout pregnancy, placenta accreta may remain largely asymptomatic. Toward the end of pregnancy, vaginal bleeding sometimes occurs. However, this bleeding is not a compelling sign. Ultrasound examination can usually bring the phenomenon to light while still pregnant. About half of all patients with placenta accreta also suffer from a defective position of the placenta during pregnancy. Sometimes, however, the condition remains undetected until birth and only becomes apparent during the birth process. In yet other scenarios, the pregnancy must be terminated prematurely due to heavy bleeding within the placenta accreta, which puts the baby and the mother at risk. Usually, early delivery occurs at a time when the embryo is already mature and fully viable.
Diagnosis and course of the disease
Meanwhile, due to advances in sonography, placenta accreta is usually detected before the actual delivery. Above all, the experience of the attending physician plays an important role in early detection. The course of placenta accreta is determined by its severity. The time of diagnosis can also influence the course. If the phenomenon is not detected until birth, the course is determined primarily by the responsiveness of the obstetricians. If the anomaly is detected before birth, cesarean section is usually recommended as the mode of delivery from the outset, which generally reduces complications.
Complications
In most cases, placenta accreta does not result in any particular complications. In this case, the pregnancy itself also proceeds normally and is not associated with pain or other discomfort. However, the woman may suffer from vaginal bleeding toward the end of pregnancy. In most cases, the placenta accreta also causes the placenta to be in the wrong position, so that vaginal birth is no longer possible.In serious cases, however, the pregnancy must be interrupted in the worst case if the pregnancy may pose a risk to the child and the mother. Likewise, an early delivery can be initiated to avoid further complications. The child does not usually suffer any particular harm or complications. In case of heavy bleeding, the woman is dependent on blood transfusions. Similarly, placenta accreta may also occur in subsequent pregnancies, so they are subject to consultation with a physician. In some cases, the patient’s uterus must be completely removed after delivery. The life expectancy of the child and the mother is not affected by placenta accreta if the birth is successful.
When should you see a doctor?
During pregnancy, placenta accreta often goes unnoticed. It is not until the last trimester of pregnancy that vaginal bleeding may occur and need to be diagnosed by a doctor. The gynecologist can clarify the causes and will also consider placenta accreta as a trigger. Often, the condition is discovered during ultrasound examinations during pregnancy. If heavy bleeding occurs shortly before the planned delivery date, the doctor in charge should be informed. It may be necessary to terminate the pregnancy prematurely to avoid endangering the mother and baby. Usually, the baby is already viable at this point and the delivery proceeds without complications. If the pregnancy recurs, a comprehensive examination of the uterus must be performed because placenta accreta may recur. Usually, the patient is advised to have a cesarean section for subsequent births. Affected women should talk to their gynecologist about the details and, if necessary, involve a therapist in the consultation.
Treatment and therapy
Treatment of placenta accreta at birth may correspond to conservative techniques such as uterine artery embolization. Balloon catheterization may also be considered. Mild placenta accreta does not require incisional delivery. To minimize bleeding in a vaginal delivery, an infusion is usually given to replace volume, in addition to labor medications. Sometimes a blood transfusion becomes necessary to prevent heavy bleeding from putting the patient’s life in danger. Nevertheless, the expectant mother usually has to expect an intervention after the birth. Still in vaginal delivery, the helpers have to remove the placenta manually and usually the uterus has to be scraped after delivery. At times, removal of the entire uterus is also necessary. If this procedure is simply refused or if there is a continued desire to have children, a resection around the placenta can take place. However, the risk of complications increases with this procedure. If placenta accreta has been present once, then the risk of recurrence automatically arises in subsequent pregnancies because the complication has left scar tissue in the uterus. However, placenta accreta need not necessarily occur in subsequent pregnancies.
Prospect and prognosis
As a rule, no general prognosis can be made about the further course of placenta accreta, since the further course of the disease depends very much on the time of diagnosis and also on the severity of this disease. Therefore, the affected person should ideally see a doctor at a very early stage and also initiate treatment to prevent further complications or complaints. The earlier treatment is initiated, the better the further course of the disease usually is. If the disease is not treated, in the worst case it can lead to the death of the child and thus to a stillbirth. In many cases, treatment requires surgical intervention to alleviate the symptoms of placenta accreta. Such an operation can also prevent further complications and in most cases also cures this condition. If the child is born without complications, there will be no discomfort or other problems later in life. The health of the mother is also not affected in an ordinary birth if placenta accreta is not cured.
Prevention
Unfortunately, placenta accreta cannot be prevented.However, serious complications can still be avoided at birth if the patient agrees to an incisional birth. If placenta accreta occurs in combination with an incorrect position of the placenta and thus the birth canal is closed, the birth must take place as an incisional birth anyway.
Aftercare
In most cases, affected individuals with placenta accreta have few or no special measures of aftercare available to them. Therefore, affected individuals should ideally seek medical attention at the first symptoms and signs of the condition to prevent further worsening of symptoms or other complications. As a rule, self-healing cannot occur with placenta accreta. Special measures of an aftercare are not available after the birth of the child. Mother and child must be particularly well cared for and monitored by a physician. Likewise, after the birth, the uterus can be completely removed if placenta accreta cannot be treated in any other way. In many cases, the affected woman is dependent on the intensive support and care of her partner and her own family. This can sometimes also prevent the development of depression or other psychological upsets. After birth, the child is also dependent on permanent monitoring by a doctor. Special complications usually do not occur. The life expectancy of the child and the mother are also not reduced by the disease if it is detected and treated in time.
What you can do yourself
As part of self-help, pregnant women should participate in the regular check-ups offered during pregnancy. In these, placenta accreta is optimally detected in time so that considerations for the circumstances of the birth can be discussed and determined early. To avoid complications, doctors recommend a cesarean section. It is advisable to follow this recommendation, even though the pregnant woman had other ideas before the diagnosis was made. As soon as abnormalities and peculiarities appear during gestation, medical control is indicated. Taking measures on one’s own responsibility is not recommended. If possible, avoid excitement, stress or restlessness during pregnancy and also birth. The lifestyle should be healthy and oriented to the natural needs of mother and child. Consumption of harmful substances such as alcohol, nicotine or caffeine should be avoided. The pregnant woman needs adequate sleep, should avoid overexertion and have a lifestyle that is preparatory for the new arrival. In addition, information related to childbirth should be obtained. The clarification of open questions pursues the goal of being as well informed as possible about possible procedures and processes of the delivery. Knowing this can prevent unnecessary surprises that would contribute to overwhelm.
