Placenta accreta

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Diagram 1 Normal position of placenta

Placenta accreta is a condition where the placenta is deeply attached to the uterine wall. This occurs 1 in 2500 pregnancies. 5 – 10% of women with placenta previa has placenta accreta. There are different types of placenta accreta:

Placenta accreta: where the placenta attaches to the uterine wall but does not penetrate through the uterine muscles. This is the most common type and occurs in about 75% of cases.

Placenta increta: where the placenta attaches even deeper and even penetrates through the uterine muscles. This occurs in about 15% of all cases.

Placenta percreta: where the placenta penetrate through the uterine wall and invades other nearby structures such as the bladder. This only occurs in 5% of cases.

Who are at risk of getting placenta accreta?

Women with anterior placenta previa major and previous C-section.
Women with previous multiple C-section and placenta previa

How is the diagnosis of placenta accreta made?

This could be suspected based on risk factors such as major anterior placenta previa with previous C-section. There will be some special features suggestive of placenta accreta on ultrasound. Your doctor may then proceed to do a Doppler ultrasound or MRI to confirm the diagnosis. However, the final confirmatory diagnosis could only be made during the C-section.

What is the treatment for placenta accreta?

In all patients with suspected placenta accreta, preoperative preparation will be done in anticipation of placenta accreta. Your operation will be done by a senior obstetrician and anaesthetist. If the diagnosis is confirmed during the operation, you may require massive blood transfusion and hysterectomy due to a lot of bleeding occurring during the operation. There also may be increased risk of bladder injury especially if there is placenta percreta. Other options of treatment should be discussed with your doctor.

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