Placenta accreta

What is placenta accreta?

Placenta accreta is a serious but rare pregnancy complication.

Placenta accreta develops when the placenta implants too deeply into the wall of the uterus (womb). Sometimes, it can grow through the muscle wall all the way to the outside of the uterus.

If this occurs, the placenta will stay firmly attached to the uterus after your baby's birth, rather than separating as is usual during the third stage of labour. This can cause severe bleeding which can be life-threatening.

Placenta accreta can also cause premature birth.

If you have placenta accreta, you will need special care when you have your baby.

What are the symptoms of placenta accreta?

Placenta accreta may not cause any symptoms during pregnancy, but it may cause bleeding.

Placenta accreta can cause heavy blood loss after birth — this can be dangerous to your health and needs urgent medical attention.

If you have any vaginal bleeding during pregnancy, see your doctor. If the bleeding and pain is severe, call triple zero (000) and ask for an ambulance.

What causes placenta accreta?

Although placenta accreta is rare, it has become more common in recent years, as caesarean birth has become more common.

You have a higher chance of placenta accreta if you have a history of:

• caesarean birth
• removal of fibroids (myomectomy)
• multiple dilatation and curettages (D&Cs)

The risk also increases if:

• you are having twins or other multiple pregnancy
• you have placenta praevia
• you are older than 35 years

When should I see my doctor?

If you experience any bleeding during your pregnancy, especially during late pregnancy, you should contact your doctor or midwife as soon as possible for advice and support.

Vaginal bleeding during late pregnancy is often due to a problem with your placenta.

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How is placenta accreta diagnosed?

Placenta accreta can be difficult to diagnose.

Your doctor may diagnose the condition during routine antenatal ultrasound. Your doctor may also refer you for an MRI to confirm the diagnosis.

In some cases, placenta accreta may also only be discovered after your baby's birth.

If a diagnosis is made antenatally, your doctor will discuss the potential risks and your birth options, including if a caesarean birth is recommended.

Complications are more likely if placenta accreta is first discovered during birth.

It's important to keep your routine antennal appointments throughout your pregnancy. If you have a problem, this helps your health team find and address it early, so you and your baby have the best chance of a safe, uncomplicated birth.

How is placenta accreta treated?

Placenta accreta itself can't be treated, but there are many things you can do to maximise your chance of a safe birth and minimise the chance of complications.

If your doctor suspects you have placenta accreta during your pregnancy, they will explain it in detail and discuss with you:

• what to expect during the rest of your pregnancy
• what type of birth is recommended
• the recommended timing for birth, as you may need to birth your baby early
• the options for managing your placenta once your baby is born

You will continue to be closely monitored throughout your pregnancy. It is usually best to give birth in a major hospital with the appropriate medical support.

You may need to spend some weeks in hospital, even before your baby is born.

In most cases of placenta accreta, it is safest to birth your baby via caesarean. However, if your placenta is high up in the uterus or only stuck in a very small area, you may have more options. Your obstetrician will discuss the safest treatment options to reduce your chance of major blood loss and infection.

In many cases of placenta accreta, your doctor is likely to recommend:

• a blood transfusion before, during or after birth
• a hysterectomy (removal of your uterus) to avoid heavy bleeding

If you wish to keep your uterus, your obstetrician may consider leaving the placenta inside the uterus. This will depend on your specific situation.

If you choose not to have a hysterectomy, you should have regular check-ups and tests in the months after having your baby to ensure your health.

What are the risks to you and your baby?

The risks of placenta accrete can be life-threatening and can include:

• heavy blood loss (postpartum haemorrhage) days or weeks following the birth
• having your baby early (prematurely)
• needing a blood transfusion
• needing a hysterectomy
• a serious infection

1 in 3 people who have placenta accreta will go on to need a hysterectomy.

If you have placenta accrete, your baby is more likely to be born early ('pre-term', or 'premature'). Depending on how early they are born, and if they have any other health condition, they may also need to spend some time in the neonatal intensive care (NICU) section of the hospital.

Speak to your doctor about the best management options to reduce your risk of complications.

What can I expect recovering from placenta accreta?

If you needed to give birth urgently following a placental abruption you or your baby may need to recover for longer than expected in hospital.

Whether you had a vaginal or caesarean birth, recovery can be more difficult if your birth didn't go as planned.

If you experience unexpected problems during pregnancy and birth, you may feel disappointed, sad or distressed. It's important to speak with your medical team about how you are feeling so they can help you and your family through your recovery.

Learn more about the emotional impact of birth trauma.

If you need to talk to someone about your mental health call Beyond Blue on 1300 22 4636.

Resources and support

For more information and support:

• The Royal Women's Hospital has further information on placenta problems.
• Westmead Hospital in NSW has further information about medical problems in pregnancy including problems with the placenta.
• The Australian Birth Trauma Association offers advice, resources, and a peer support service.
• The Centre of Perinatal Excellence (COPE) provides information and a list of support services.
• Perinatal Anxiety & Depression Australia (PANDA) — call 1300 726 306 to speak with a counsellor. They are available from Monday to Friday from 9am to 7.30pm Australian Eastern Time.

Do you prefer to read in languages other than English?

• The NSW Government offer a Having a baby book in English and other languages.