Placenta Accreta: Management and Delivery

Posted On: September 15, 2022 By Nathan D. Fox, MD

Placenta accreta is a high-risk pregnancy condition that occurs when the placenta grows too deeply into the uterine wall. This can cause severe blood loss after delivery. Women who have been diagnosed with this condition may have questions regarding how to best manage it and what to expect. Read on as Dr. Nathan Fox and Dr. Brett Einerson, Assistant Professor in the Division of Maternal-Fetal Medicine at the University of Utah Health, discuss this topic.

How to Manage Placenta Accreta

Following Diagnosis

If your doctor is fairly sure that you have placenta accreta, then they will begin to plan for the delivery day right away, which may include a C-section followed by a hysterectomy. Patients should practice pelvic rest, which means no intercourse. You will see your doctor at least every month to do an ultrasound to follow the location of the placenta. As the surgery date gets closer, you may be asked to move 30-45 minutes from the hospital. If planned preterm delivery is scheduled, steroids may also be considered to help the baby’s organs mature to get ready for delivery. Your red blood cell count and iron stores will also be tested to ensure that they are normal in the case that heavy bleeding does occur.

As with any high-risk pregnancy, be sure to listen to your body, and do not hesitate to contact your obstetrician if you are concerned. “What I tell people is, you know, you have any concerns, you’ve got to call in,” said Dr. Einerson. “And I kind of treat these patients a little bit more, I don’t wanna say preciously, but a little bit more intentionally than other patients.”

Meeting Key Players

Following your first consultation with your obstetrician, you will also meet a number of people before the delivery date. This will include an OB anesthesiologist with specialized training to take care of women who have serious obstetric issues. This anesthesiologist will speak with you regarding what the experience is going to be like from an aesthetic standpoint. “We do try to keep patients awake for the C-section part so that they can see and hear their baby,” Explained Dr. Einerson, “But then they go to sleep for the hysterectomy portion if we’re gonna do a hysterectomy. And so, meeting with an anesthesiologist to go over their health problems and to talk through sort of the, this is gonna happen, then this is gonna happen is really helpful for patients.”

The other team that you will meet with will be a group of counselors and social workers. Because placenta accreta can be a scary or stressful situation for some, getting to know counselors beforehand can be helpful if you feel the need to speak with someone following childbirth.

Have a Go-To Plan

If you have placenta accreta and have children you are caring for at home, it is good to have a plan regarding who will care for the kids if you do have to stop what you’re doing and go to the hospital. You should also plan to have someone else at home with you during the night, just in case. It is overall helpful not to have to worry about who is going to care for your children during a stressful event.

Will You Need a Hysterectomy?

Some women with placenta accreta will require a hysterectomy following their C-section while others will not. Individuals who have the best chance of not needing a hysterectomy are those who are suspected to have accreta but not previa, or an area of stuck placenta somewhere that is not low down. “If it’s confined to a very small area on the middle of the upper part of the uterus, there’s a chance that when the placenta doesn’t come out, we can isolate that small area that’s affected, take out the underlying muscle with it and sew the uterus back together,” said Dr. Einerson.” And that’s probably…for a lot of patients, that is a lower risk procedure than having the whole uterus taken out. But for most patients who have accreta, specifically, if it’s a previa, that’s not a good option.”

Choose an Experienced Delivery Team

It is important to choose an experienced obstetrician or obstetrics team to deliver your baby, such as the team MFM. “Even for someone who has an accreta, in the situations where it is suspected or diagnosed or highly suspected and you’re in a good center, the overwhelming likelihood is you will have a very detailed and potentially stressful pregnancy and intricate plan for delivery, and you will deliver and walk out of the hospital holding a healthy baby,” said Dr. Fox. “And that’s the most likely thing that’s gonna happen if you’re getting good care.”

To learn more about what to expect with placenta accreta, schedule an appointment with MFM Associates/Carnegie Imaging for Women specialist. Contact our office today!

 

 

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

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