Placenta accreta is a condition when the placenta grows too deep in the uterine wall. This condition is one of the problems of pregnancy which serious because it can cause severe bleeding anddamage 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 usually separates 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.
Reason Placenta Acreta
The exact cause of placenta accreta is not known. However, this condition is thought to be related to abnormal uterine wall conditions, such as scar tissue that forms after a cesarean section or other uterine surgery.
Risk factors for placenta accreta
Placenta accreta can occur in any pregnant woman. However, there are a number of factors that can increase a woman's risk of developing placenta accreta, including:
- Have you ever had a cesarean 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 when pregnant
- Suffering from placenta previa (placenta covers part or all of the birth canal)
- Getting pregnant through IVF procedure
Symptoms of Placenta Acreta
During pregnancy, placenta accreta generally does not cause symptoms and signs that can be seen with the naked eye. 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 go to the doctor
Although generally asymptomatic, placenta accreta can be detected on ultrasound examination during pregnancy consultations. Therefore, check with the doctor regularly so that the condition of your pregnancy is always monitored.
If you are at risk for placenta accreta, talk to your doctor about the possibility of having placenta accreta.
Go to the hospital emergency room immediately if you experience vaginal bleeding during pregnancy. Vaginal bleeding can be a sign of placenta accreta.
Diagnosis of Placenta Acreta
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 an MRI of the uterus. This examination is necessary to determine the location of the uterus and how deeply the placenta is implanted 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 to penetrate the entire wall of the uterus and attaches to other organs, such as the bladder
Penwishful thinkingan Acreta Placenta
In placenta accreta that does not cause complaints to pregnant women, the doctor will observe the condition of the pregnancy periodically. The doctor will also plan the time of delivery and make various preparations to ensure a safe delivery.
Meanwhile, if the patient experiences bleeding in the third trimester, the doctor will advise the patient to rest completely and undergo treatment in the hospital.
Delivery in patients with placenta accreta was performed by caesarean section. There are two options that doctors can do, namely caesarean section with a hysterectomy and caesarean section with preserving the uterus.
Cesarean section with hysterectomy
Cesarean section followed by hysterectomy is the safest option for placenta accreta, especially if placenta increta or percreta has occurred.
A 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 was not able to get pregnant again after undergoing this procedure.
Caesarean section with preserving the uterus
For patients who still want to have children or whose placenta accreta condition is not too severe, doctors can try a caesarean section by maintaining the presence of the uterus.
This technique involves leaving the placenta in the uterus, and waiting for the placenta to shed on its own (usually within 4 weeks), or to fuse with the uterine wall (usually within 9–12 months). Another technique is to remove part 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 that can lead to sepsis. If these complications occur, a hysterectomy will still be performed.
Complications of Placenta Acreta
Generally, complications of placenta accreta occur after surgery. Some of these complications are:
- Heavy bleeding after delivery, which can cause organ damage, such as acute respiratory distress syndrome or kidney failure, and can be life threatening
- Premature birth, if placenta accreta causes bleeding before delivery
- Damage to the uterus or surrounding organs
For patients who retain the presence of the uterus, complications can occur in subsequent pregnancies, such as miscarriage and recurrence of placenta accreta. Meanwhile, complications that can occur in patients undergoing cesarean section with hysterectomy, include:
- Surgical wound infection
- Allergic reactions to anesthetics
- Blood clotting
Prevention of Placenta Acreta
Placenta accreta is difficult to prevent, but the risk of complications from the condition can be lowered. The trick is to consult a gynecologist on a regular basis, so that the condition of the uterus and the development of pregnancy are always monitored.