Kim Kardashian recently discussed the strong recommendation from her obstetrician, that she not have any more babies due to a medical complication in her first two pregnancies called placenta accreta. The headlines and hype about the issue gives us an opportunity to explore the growing incidence and nature of this complication of pregnancy and childbirth.
Placenta Accreta can be a serious condition that occurs when the placenta attaches too firmly to the uterine wall. Although the placenta implants at its proper, anatomical location within the uterus, the blood vessels and other placental elements grow abnormally in tissue and do not release naturally during labor. In the case of Kim Kardashian, her obstetrician had to scrape it out manually at birth in what she described as the “most painful experience” of her life.
There are three categories of this type of placental complication. The most common and basic is actual Placenta Accreta, where the placenta attaches too deeply to the uterine wall but does not penetrate through the inner wall to the uterine muscle. Placenta Increta is where the placenta attaches deeper into the wall and penetrates uterine muscle. In Placenta Percreta the placenta attaches so deeply that it comes through beyond the muscular wall of the uterus and attaches onto one or more nearby organs, often the bladder.
The risk of Placenta Accreta increases after having uterine surgery such as a previous cesarean birth and rises with each subsequent procedure. The theory behind the connection is that incisions on the uterine wall and muscle leave scar tissue that forces the placenta to become more aggressive during implantation. All three forms have increased significantly in occurrence in the United States in recent years. Studies reveal that Placenta Accreta occurred in 1 in 533 pregnancies from 1982-2002 compared to the 1970’s rate of 1 in 4,027 pregnancies. With the rate of cesarean continuing to rise dramatically since 2002, the actual rate of Placenta Accreta today is likely much higher as well. Very few people are sufficiently notified or warned about the increased risk of Placenta Accreta before they undergo a cesarean birth.
Placenta Accreta may be diagnosed during pregnancy or at birth. Learning of the condition through imaging such as ultrasonography during pregnancy provides the opportunity to assemble a multidisciplinary team to monitor the pregnancy and create a specific birth plan optimizing the chances for a safe delivery and removal of the placenta. Many women diagnosed with Placenta Accreta while pregnant are encouraged to deliver via planned cesarean before 39 weeks - sometimes much earlier - and are often recommended to have a hysterectomy (removal of the uterus) to prevent hemorrhage and other major complications.
However, cesarean is not always necessary or the best option. Other solutions can be used to prevent blood loss and other complications and steps can be taken to preserve the uterus, especially if additional pregnancies are desired. Each case is different, and not all options are available or effective for every person or pregnancy. If you are diagnosed with a form of Placenta Accreta during pregnancy, speak with your obstetrician about your options. You can find valuable information at Hope for Accreta and the American Pregnancy Associationand the American Congress of Obstetricians and Gynecologists and be in a better position to make informed choices and find support for those choices.