If you're in the second trimester of your pregnancy and experiencing spotting or clots, your ob-gyn may say to "wait and see" whether the placenta moves up from your cervix, which might indicate you have placenta accreta. However, if your symptoms occur in the third trimester, your doctor might be more concerned that placenta accreta could be the culprit.
Placenta accreta is a condition in which the placenta holds tightly to the uterine wall, but does not pierce the muscle of the uterus. This and other conditions where the placenta attaches too deeply to the uterus only occur in a small fraction of pregnancies (less than 1 in 2,500). Usually, this condition is identified prior to delivery. But sometimes, it is not discovered until childbirth is in progress.
Possible Causes of Placenta Accreta
There are certain circumstances that can occur during pregnancy that boost the chances of developing placenta accreta. One of these is placenta previa (this is when the placenta, which may be lying too low in the uterus, partly blocks the cervix).
Placenta accreta may also be related to previous cesarean deliveries. Expectant women at greatest risk for this condition are those who have some damage from a prior C-section. In fact, over 60 percent of those experiencing placenta accreta have had multiple cesarean births.
With placenta acrreta there is also a higher risk of other injury (related to scars resulting from prior surgeries or having had placenta accreta with a previous caesarian birth).
Concerns and Solutions
With the diagnosis of placenta accreta, the concerns include:
There may be hemorrhaging during childbirth.
Damage to the uterus or other organs may occur during attempts to dislodge the placenta from the uterine wall.
Premature delivery could result.
Interventions such as hysterectomy may be recommended, which would prevent the mother from conceiving in the future.
The good news is, when placenta accreta is diagnosed before delivery, it gives the medical team time to develop a multidisciplinary plan to reach the best outcome possible.
Available Treatments
Just as there are no preventive measures known for this condition, there also are no clearly effective treatments available to date. Should you get a diagnosis of placenta accreta, you can work with your doctor who will monitor your pregnancy closely. You may also schedule your delivery to include surgery aimed at saving the uterus. It is especially important to communicate well (and often) with your physician if you are planning to have more babies in the future.
The usual way to manage placenta accreta is to plan a cesarean hysterectomy, leaving the placenta intact. This is done in order to prevent hemorrhaging and, at the very least, to follow a protocol to manage any hemorrhaging. But each case is unique, and surgical management is handled on a case-by-case basis. If you are concerned about placenta accreta, you can speak with your doctor about what plan is in place for handling an emergency delivery, just in case it is needed.