In placenta accreta, the placenta has grown together with the muscle of the uterus. As a result, heavy bleeding occurs during vaginal birth, which necessitates a section birth. Doctors suspect scar tissue in the uterus to be the cause of the phenomenon.
What is placenta accreta?
In placenta accreta, the musculature of the uterus has grown together with the placenta. After the birth process, there is no natural detachment of the placenta. Heavy bleeding is usually associated with childbirth. Around one in 2,500 pregnant women currently suffers from placenta accreta. Also known as adherent placenta, the condition can cause serious complications during childbirth. See sportingology for Meaning of Cat Allergy in English.
There are several forms of placenta accreta. The most severe form is placenta increta or placenta percreta. One of the easiest forms is the special form of the placenta adhaerens. The suspicion of placenta accreta usually arises long before the birth, so that the pregnant woman can either agree to a section birth in advance or, despite the risk of complications, request a vaginal birth with appropriate preparations.
Causes
In placenta accreta, the lining of the uterus is missing or at least not well developed. This allows the trophoblasts to grow unhindered onto the musculature of the uterus. In some cases, the trophoblasts even grow into the muscle of the uterus. Ingrown trophoblasts correspond to severe placenta accreta. On the other hand, only grown trophoblasts are found in the lighter forms.
Scar tissue on the uterus can also cause placenta accreta. In this case, Asherman’s syndrome, for example, can be considered as the primary cause, which is usually preceded by uterine surgery or a caesarean section. Experts therefore consider the increasing trend towards caesarean sections in the 21st century to be the main reason for the increased rate of placenta accreta.
Fibroid removal or curettage sometimes also cause Asherman syndrome. After the age of 35, the general risk of pregnancy complications increases. The risk of placenta accreta also increases with the general risk of complications.
Symptoms, Ailments & Signs
Placenta accreta can remain largely symptom-free throughout pregnancy. Vaginal bleeding sometimes occurs towards the end of pregnancy. However, this bleeding is not a compelling sign. The ultrasound examination can usually bring the phenomenon to light during pregnancy.
Around half of all patients with placenta accreta also suffer from an incorrect position of the placenta during pregnancy. Sometimes, however, the phenomenon remains undetected until birth and only becomes apparent during the birth process. In still other scenarios, the pregnancy has to be terminated prematurely because of the heavy bleeding that occurs during the placenta accreta, which endangers the child and the mother. As a rule, the early delivery takes place at a time when the embryo is already mature and fully viable.
Diagnosis & course of disease
Thanks to advances in sonography, placenta accreta is now usually detected before the actual birth. Above all, the experience of the attending physician plays an important role in early detection. The course of the placenta accreta is determined by the severity of the phenomenon. The time of diagnosis can also influence the course.
If the phenomenon is only recognized at birth, the course is mainly determined by the speed of reaction of the obstetrician. If the anomaly is detected before birth, a caesarean section is usually recommended as the mode of delivery from the outset, which usually reduces the complications.
Complications
In most cases, the placenta accreta does not cause any particular complications. The pregnancy itself is also normal and is not associated with pain or other discomfort. However, at the end of pregnancy, the woman may suffer from vaginal bleeding.
In most cases, the placenta accreta also puts the placenta in the wrong position, so that a vaginal birth is no longer possible. In serious cases, however, the pregnancy must be terminated in the worst case if the pregnancy can pose a danger to the child and the mother. Early delivery can also be initiated to prevent further complications.
The child usually does not suffer any special damage or complications. If the bleeding is severe, the woman is dependent on blood transfusions. Placenta accreta can also occur in the subsequent pregnancies, so that these are subject to consultation with a doctor. In some cases, the patient’s uterus must be completely removed after childbirth. The life expectancy of the child and the mother is not affected by the placenta accreta in the case of a successful birth.
When should you go to the doctor?
Placenta accreta often goes unnoticed during pregnancy. Vaginal bleeding, which must be diagnosed by a doctor, can only occur in the last third of pregnancy. The gynecologist can clarify the causes and will also consider a placenta accreta as a trigger. The condition is often discovered during ultrasound scans during pregnancy. If heavy bleeding occurs shortly before the planned delivery date, the responsible doctor must be informed. The pregnancy may have to be terminated prematurely in order not to endanger mother and child.
Most of the time, the baby is already viable at this point and the delivery is uncomplicated. If you become pregnant again, a comprehensive examination of the uterus must be carried out, because placenta accreta can occur repeatedly. Usually, the patient is advised to have a Caesarean section for subsequent births. Affected women should talk to the gynecologist about the details and, if necessary, also involve a therapist in the consultation.
Treatment & Therapy
Treatment of placenta accreta at delivery may correspond to conservative techniques such as uterine artery embolization. Balloon catheterization is also conceivable. In the case of mild placenta accreta, no incisional birth is necessary. In order to minimize bleeding during a vaginal birth, in addition to labor drugs, an infusion treatment is usually given, which serves to replace volume.
Sometimes a blood transfusion is necessary so that heavy bleeding does not endanger the patient’s life. Nevertheless, the mother-to-be usually has to expect an operation after the birth. Even during vaginal birth, the helpers have to remove the placenta manually and the uterus usually has to be scraped out after the birth. Sometimes the entire uterus needs to be removed. If this procedure is simply refused or if there is a desire to have more children, a resection can take place around the placenta.
However, the risk of complications increases with this procedure. Once placenta accreta has occurred, subsequent pregnancies are automatically at risk of recurrence because the complication has left scar tissue in the uterus. Placenta accreta does not necessarily have to occur in subsequent pregnancies.
Outlook & Forecast
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 consult a doctor very early on and also initiate treatment so that there are no further complications or symptoms. The earlier treatment is initiated, the better the further course of the disease.
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, a surgical intervention is necessary to relieve the symptoms of the placenta accreta. Such an intervention can also prevent further complications and in most cases cure this disease as well. If the child is born without complications, there will be no complaints or other problems in later life. The mother’s health is also unaffected by an ordinary birth if the placenta accreta is not cured.
Prevention
Unfortunately, placenta accreta cannot be prevented. However, serious complications can still be avoided during childbirth if the patient agrees to a section birth. If the placenta accreta occurs in combination with an incorrect position of the placenta and the birth canal is closed, the birth must take place as a section birth anyway.
Aftercare
In most cases, those affected by placenta accreta have few or no special follow-up measures available. Ideally, those affected should consult a doctor as soon as the first symptoms and signs of the disease appear in order to prevent further deterioration of the symptoms or other complications. As a rule, placenta accreta cannot heal itself.
Special aftercare measures are not available after the birth of the child. Mother and child must be particularly well cared for and checked by a doctor. The uterus can also be completely removed after the birth if the placenta accreta cannot be treated in any other way. In many cases, the affected person is dependent on the intensive support and care of their partner and their own family.
This can sometimes also prevent the development of depression or other mental disorders. After birth, the child is also dependent on constant monitoring by a doctor. Special complications usually do not arise. The life expectancy of the child and the mother are not reduced by the disease if it is recognized and treated in good time.
You can do that yourself
As part of self-help, pregnant women should take part in the regularly offered check-ups during pregnancy. In these, the placenta accreta is ideally discovered in good time, so that the considerations for the circumstances of the birth can be discussed and determined at an early stage. To avoid complications, doctors recommend a caesarean section. It is advisable to follow this recommendation, even if the pregnant woman had other ideas before the diagnosis was made.
As soon as abnormalities and peculiarities become apparent during the gestation, a medical check-up is indicated. Taking action on your own responsibility is not recommended. If possible, excitement, stress or unrest should be avoided during pregnancy and birth.
The lifestyle should be healthy and based on the natural needs of mother and child. The 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 to the new arrival.
In addition, information about the birth must be obtained. The clarification of open questions pursues the goal of being informed as best as possible about possible processes and processes of childbirth. Knowing this can prevent unnecessary surprises that would contribute to overwhelm.
