Part 2: What is placenta accreta?
So, what is placenta accreta? Well, in a normal pregnancy, the placenta (the organ that supplies oxygen, nutrients and other support to the developing baby) attaches itself to the uterus wall. After the baby is delivered, then the placenta gets delivered. It normally just releases itself from the uterine wall and comes out in one piece. With placenta accreta, the placenta attaches itself too deeply into the uterus wall. Although mine appeared to come out with no problem in one whole piece after I delivered my son, we later discovered that wasn’t the case.
Placenta accreta is not something I had ever heard of, even though I have a health-related degree, and I was in the middle of my training to become a birth doula at the time I was diagnosed. After I was given my diagnosis, I researched it to get more information. I was trying to figure out why it happened to me and why my doctors didn’t catch it sometime throughout my pregnancy instead of ten days after in a D&C procedure that had some unexpected twists.
I tend to feel like I’m always the exception to the rule when it comes to health issues, and this one was no different. Through my research, I discovered that it is not a very common condition, although it is on the rise, due to an increase in cesareans which is a major risk factor for accreta. I had never had a cesarean, or any previous uterine surgeries, or placenta previa, or in vitro fertilization, nor was I of advanced maternal age. I had not one of those risk factors, yet I still ended up with placenta accreta. So, to answer my question of “why didn’t the doctors catch this before my delivery?”, well, there was no reason for them to be looking for it. With no known risk factors, and an otherwise healthy pregnancy, there was no reason for me to have any scans outside of the routine ultrasound at 20 weeks. Yes, on occasion an accreta can be caught with an ultrasound, but it’s very tricky to diagnose without an MRI.
There are three different levels of accreta; Accreta, increta, and percreta, with percreta being the most severe. With percreta, the placenta attaches itself and actually grows the whole way through the uterine wall and can begin to attach to other nearby organs such as the bladder.
While every woman’s experience is different, this condition has the potential to bring on a lot of complications. These can include one or many of the following: planned cesarean-hysterectomy (c-hyst) surgery (which inherently means loss of fertility), damage to surrounding organs, weeks or even months of bed rest, NICU time for baby, and ICU time for mom. To complicate the condition even more, accreta is often accompanied by placenta previa, where the placenta covers the cervix, therefore making a vaginal delivery impossible and increasing the risk for bleeding and hemorrhaging throughout pregnancy.
On top of the physical aspects of this condition, it can cause a lot of emotional damage to not only mom, but the entire family. Whether they want to or not, many women lose their fertility because they have to undergo a c-hyst (to lessen the risk of life threatening hemorrhages), but in many cases families are also forced to consider a very real possibility of maternal death. Sometimes women even write letters or make videos for their unborn child or their older children in case they don’t make it through the surgery. Moms can be taken away from their families for weeks or even months while they’re stuck in a hospital so that they can be monitored closely waiting for the right time for the safest possible delivery, often leaving a heavy burden on their loved ones to take care of the home and any other children. The aftermath of placenta accreta can also often times include post-partum depression, anxiety, and even PTSD.
Although we won’t ever be able to stop accreta from occurring my hope is to spread awareness so that women have the opportunity to make more informed decisions.