Placenta accreta

Placenta accreta is a rare but serious 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 happens, the placenta will stay firmly attached to the uterus after your baby is born, instead of separating like it usually does during the third stage of labour. This can cause heavy bleeding which can be life-threatening.

Placenta accreta usually means you will need to have your baby early.

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

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.

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

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.

Placenta accreta can be difficult to diagnose.

Your doctor may diagnose the condition during routine antenatal ultrasound. Your doctor may also send you for an MRI (Opens in new tab) to confirm the diagnosis.

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

If a diagnosis is made before your baby is born, your doctor will discuss the potential risks and your birth options, including whether a caesarean birth is recommended.

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

It's important to keep your routine antenatal 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 for a safe, uncomplicated birth.

Placenta accreta itself can't be treated, but there are many ways to help make your birth safer and reduce 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 about:

• 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

Because placenta accreta has some risks, you will usually be cared for by a multidisciplinary team — a group of healthcare specialists with different expertise. They will adjust care to meet your individual needs.

You will continue to be closely monitored throughout your pregnancy. It’s 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 deliver your baby by caesarean. If your placenta is high in the uterus or only stuck in a very small area, you may have more choices. Your obstetrician will discuss the safest treatment options to lower your chance of heavy bleeding and infection.

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

• a blood transfusion (Opens in new tab) before, during or after birth
• a hysterectomy (Opens in new tab) (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 your baby is born to ensure your health.

It's important for your healthcare team to help you understand what is happening to you and your baby. You should take part in decisions about your and your baby's health — this is called shared decision making.

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

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

1 in 3 people with placenta accreta will need a hysterectomy.

If you have placenta accreta, your baby is more likely to be born early ('pre-term', or 'premature'). Depending on how early they are born, and if they have other health conditions, 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.

If you have placenta accreta and need to give birth urgently, you or your baby may need to stay in hospital for longer to recover.

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

If you need to have a hysterectomy, you will often have feelings of loss and sadness.

Most women do not expect a rare and serious complication during their pregnancy. Being diagnosed with placenta accreta may come as a surprise.

Learning that your condition is serious can feel scary. It’s normal to feel many different emotions at this time. Having a complicated pregnancy puts a lot of pressure on you and your family.

Depending on your situation, these feelings may be mild or severe. It’s important to talk with your medical team during your pregnancy and birth. Share how you feel so they can help you and your family while you recover. They can offer advice and helpful information. Talking about your feelings is important and will help you heal both physically and mentally.

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.

For more information and support:

• The Royal Women's Hospital (Opens in new tab) has further information on placenta problems (Opens in new tab).
• Westmead Hospital (Opens in new tab) in NSW has further information about medical problems in pregnancy, including placenta accreta (Opens in new tab).
• The Australian Birth Trauma Association (Opens in new tab) offers advice, resources, and a peer support service.
• The Centre of Perinatal Excellence (COPE) (Opens in new tab) provides information and a list of support services.
• Call Perinatal Anxiety & Depression Australia (PANDA) (Opens in new tab) on 1300 726 306 to speak with a counsellor.