Placenta Accreta

Placenta Accreta

Placenta accreta is a condition when the placenta (placenta) grows too deep in the uterine wall. This condition is a serious pregnancy problem because it can cause heavy bleeding and damage to the uterus .

The placenta is an organ that forms in the uterus during pregnancy. This organ functions as a distributor of oxygen and nutrients from the mother to the fetus. After a mother gives birth, a normal placenta will usually detach from the uterine wall.

In patients with placenta accreta, part or all of the placenta remains firmly attached to the uterine wall because it grows too deep. This can cause heavy bleeding after delivery.

Causes of Placenta Accreta

The cause of placenta accreta is not known with certainty. However, this condition is thought to be related to abnormal uterine wall conditions, such as scar tissue that forms after a caesarean section or other uterine operations.

Risk factors for placenta accreta

Placenta accreta can occur in every pregnant woman. However, there are a number of factors that can increase a woman's risk of having placenta accreta, namely:

  • Have had a caesarean section or other uterine surgery, such as myoma surgery
  • Over 35 years old
  • Having the position of the placenta at the bottom of the uterus during pregnancy
  • Suffering from placenta previa (placenta covering part or all of the birth canal)
  • Pregnant through IVF procedure

Symptoms of Placenta Accreta

As pregnancy progresses, placenta accreta generally does not cause visible signs and symptoms. However, if it occurs together with placenta previa, bleeding from the vagina can occur in the 28th to 40th week of pregnancy (third trimester).

When to see a doctor

Although generally asymptomatic, placenta accreta can be detected on an ultrasound examination during a pregnancy consultation. Therefore, check with your doctor regularly so that the condition of your pregnancy is always monitored.

If you are at risk of having placenta accreta, discuss with your doctor about the possibility of placenta accreta.

Immediately go to the hospital emergency room if you experience bleeding from the vagina during pregnancy. Bleeding from the vagina can be a sign of placenta accreta.

Diagnosis of Placenta Accreta

The doctor will ask about the patient's symptoms and medical history. After that, the doctor will carry out supporting examinations, such as a pregnancy ultrasound or uterine MRI. This examination is needed to find out the location of the uterus and how deep the placenta is embedded in the uterus.

The severity of the condition of the attachment of the placenta to the uterine wall can be divided into three, namely:

  • Placenta accreta, which is a condition when the placenta grows too deep in the uterine wall
  • Placenta increta, which is a condition when the placenta grows until it reaches the uterine muscle
  • Placenta percreta, which is a condition when the placenta grows until it penetrates the entire wall of the uterus and attaches to other organs, such as the bladder

Management of Placenta Accreta

In placenta accreta that doesn't cause complaints in pregnant women, the doctor will periodically observe the condition of the pregnancy. The doctor will also plan the delivery time and make various preparations to ensure the delivery goes safely.

Meanwhile, if the patient experiences bleeding in the third trimester, the doctor will advise the patient to rest completely and undergo treatment at the hospital.

Delivery in patients with placenta accreta is performed by caesarean section . There are two options that doctors can do, namely caesarean section with hysterectomy and caesarean section by preserving the uterus.

Caesarean section with hysterectomy

A caesarean section followed by a hysterectomy is the safest option for placenta accreta, especially if a placenta increta or percreta has already occurred.

Hysterectomy is the removal of the uterus (with the placenta still in the uterus). By removing the uterus as well as the placenta, heavy bleeding due to the act of separating the placenta from the uterine wall can be prevented. However, the patient cannot become pregnant again after undergoing this procedure.

Caesarean section with preservation of the uterus

For patients who still want to have children or whose placenta accretion is not too severe, doctors can arrange a cesarean section by preserving the presence of the uterus.

This technique is performed by leaving the placenta in the uterus, and waiting for the placenta to decay on its own (usually within 4 weeks), or fuse with the uterine wall (usually within 9-12 months). Another technique is to remove a portion of the uterus that is tightly attached to the placenta.

Please note, this surgical technique has a high risk of causing serious complications, such as heavy bleeding or infection which can become sepsis . If these complications occur, a hysterectomy will still be performed.

Complications of Placenta Accreta

Generally, complications of placenta accreta occur after surgery. Some of these complications are:

  • Severe bleeding after delivery , which can cause organ damage, such as acute respiratory syndrome or kidney failure, and can be life threatening
  • Premature birth, if the placenta accreta causes bleeding before delivery
  • Damage to the uterus or nearby organs

For patients who still maintain the presence of the uterus, complications may occur in subsequent pregnancies, such as miscarriage and recurrence of placenta accreta. Meanwhile, complications that can occur in patients who undergo caesarean section with hysterectomy include:

  • Surgical wound infection
  • Allergic reaction to the anesthetic
  • Blood clotting

Prevention of Placenta Accreta

Placenta accreta is difficult to prevent, but the risk of complications from this condition can be reduced. The trick is to consult an obstetrician regularly, so that the condition of the uterus and the development of pregnancy are always monitored.

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