Placenta accreta at a glance

• Placenta accreta is a high-risk pregnancy complication. It occurs when the placenta attaches too deeply to the uterus.
• This condition can cause severe blood loss after delivery and increase the risk of preterm birth.
• Placenta accreta is often linked to abnormalities in the uterine lining caused by scarring from a previous C-section or other uterine surgery.
• Advances in imaging and testing allow obstetricians to diagnose the condition early, often during a routine ultrasound.
• If placenta accreta is suspected during pregnancy, the patient will likely need an early C-section followed by a hysterectomy.
• Surgery outcomes are often better when performed by a gynecologic oncologist or another surgeon with specialized training in women's reproductive health.
• The CU Medicine has the region's only placenta accreta program.

What is placenta accreta?

Placenta accreta is a condition in which the placenta grows too deeply into the uterine wall. As a result, part or all of the placenta may remain attached after delivery.

This condition can cause serious complications, including:

• Premature labor
• Heavy bleeding during pregnancy
• Hemorrhage after delivery

Hemorrhage can lead to life-threatening conditions. These include disseminated intravascular coagulopathy, a disorder that prevents blood from clotting normally, as well as lung or kidney failure.

During pregnancy, the placenta provides oxygen and nutrients to the baby. It also removes waste from the baby's blood.

After delivery, the placenta normally separates from the uterine wall and is delivered as part of the afterbirth. With placenta accreta, the placenta does not separate normally because it has grown into the uterine wall.

About 1 in 530 pregnancies are affected by placenta accreta or the related conditions placenta increta and placenta percreta. The difference between these conditions is how deeply the placenta attaches to the uterine wall.

Types of placenta accreta spectrum disorders

Placenta accreta

The placenta attaches to the lining of the uterus. This is the most common form.

Placenta increta

The placenta grows deeper into the muscle wall of the uterus.

Placenta percreta

The placenta grows through the uterus and may extend into nearby organs, such as the bladder.

Women diagnosed with placenta accreta work closely with their obstetrician and care team to create a delivery plan. The goal is to reduce risks for both mother and baby. This plan may include a cesarean hysterectomy, which is the removal of the uterus after a C-section.

In less severe cases, conservative surgical management may be an option. This may involve leaving all or part of the placenta in place with the hope that it will detach later.

Placenta accreta is often diagnosed early in pregnancy. However, some cases are not discovered until late in pregnancy or during delivery. In rare situations, the condition is identified when the placenta does not separate after birth. Emergency treatment may then be required, including blood transfusions and surgery.

Causes of placenta accreta

The exact cause of placenta accreta is unknown. However, according to the American College of Obstetricians and Gynecologists (ACOG), rates have increased and are strongly linked to the rise in C-section deliveries.

Women who have had multiple C-sections have a higher risk of developing placenta accreta.

Other risk factors include:

• Placenta position: Risk is higher when the placenta partly or completely covers the cervix (placenta previa) or sits low in the uterus.
• Age: Women age 35 and older have a higher risk.
• Previous childbirth: Risk increases with each delivery.
• Multiple pregnancy: Carrying two or more babies.
• Previous uterine surgery or conditions: Procedures to remove fibroids or other growths can increase risk. Uterine scarring also increases the chance that the placenta will attach abnormally.
• Noncancerous uterine growths: Submucosal fibroids or other abnormal growths that protrude into the uterine cavity.

Placenta accreta symptoms and diagnosis

Placenta accreta often causes no symptoms during pregnancy. In some cases, vaginal bleeding occurs during the third trimester.

Early diagnosis is important. It helps reduce risks during delivery and allows providers to develop a treatment plan for both mother and baby.

Obstetricians use several methods to diagnose placenta accreta:

Ultrasound

Placenta accreta is often found during a routine ultrasound. Ultrasound uses sound waves to create images of structures inside the body.

Magnetic resonance imaging (MRI)

MRI uses magnetic fields to create detailed images. It can help determine whether the placenta has grown into the uterine wall and show the location and extent of growth.

Blood tests

Blood tests measure levels of alpha-fetoprotein, a protein produced by the baby and found in the mother's blood. High levels have been associated with placenta accreta.

Treating placenta accreta

Placenta accreta is most often treated with a cesarean hysterectomy. This procedure is usually performed by a pelvic surgeon, such as a gynecologic oncologist who specializes in reproductive surgeries.

The C-section is typically scheduled between 34 and 36 weeks of pregnancy. This timing helps balance the health needs of both mother and baby.

Once placenta accreta is diagnosed, careful planning is essential. A multidisciplinary care team may include:

• An obstetrician
• An anesthesiologist
• A blood bank team
• A surgeon

This planning is important because placenta accreta carries a high risk of severe bleeding during delivery and surgery. With proper care and preparation, most women safely deliver healthy babies.

Treatment depends on the severity of the condition. In some cases, the full extent of placenta accreta is not known until surgery begins.

Before delivery, the patient and care team should discuss all treatment options, including future pregnancy goals.

In less severe cases, a cesarean hysterectomy may not be necessary. A skilled surgeon may leave part of the placenta in place with the hope that it detaches later.

According to ACOG, limited research suggests that women with placenta accreta who do not have a hysterectomy may face a higher risk of complications in future pregnancies. These may include:

• Miscarriage
• Premature birth
• Recurrent placenta accreta

Possible complications after a cesarean hysterectomy are similar to those associated with other surgeries and C-sections. These include:

• Infection
• Bleeding
• Fever
• Scarring
• Urinary tract injury

The only placenta accreta program in the region

The CU Medicine's placenta accreta program is the only one in the region.

The program includes a team of surgeons led by gynecologic oncologist Dr. Saketh Guntupalli. The team specializes in the management of placenta accreta and provides advanced surgical care for this complex condition.

University of Colorado Gynecologic Oncology uses a multifunctional operating room and coordinated care planning to support patients with complex diagnoses.

A multidisciplinary team is available for every surgery, including specialists in:

• Anesthesia
• Radiology
• Pediatrics
• Urology
• Interventional radiology