High-Risk Pregnancy Care
(Maternal-Fetal Medicine)

The placenta, commonly known as the afterbirth, is an organ that develops in your uterus during pregnancy. This structure provides oxygen and nutrients to your growing baby and removes waste products from your baby’s blood. The placenta attaches to the wall of your uterus, and your baby’s umbilical cord arises from it.

During the last stage of labor, the placenta will separate from the wall of the uterus, and contractions will help push it out of the birth canal after childbirth.

Sometimes, the placenta is attached deep into the uterus, and it doesn’t completely separate from the uterus during delivery, which can cause dangerous bleeding. This is referred to as Placenta Accreta Spectrum (PAS) also known as placenta accreta, placenta increta or placenta percreta depending on how deep it is attached.

Research has yet to prove why a placenta accreta will occur; however, it often happens in women who have had a prior cesarean section or surgery on the uterus, such as removal of fibroids or multiple dilation and curettage.

The layer behind the lining of the uterus called endometrium is injured during a cesarean section and it doesn’t heal back completely, leaving a space for the placenta to attach to directly and grow deeper into the muscle of the uterus.

Historically, placenta accreta was diagnosed at the time of delivery and attempts to remove the placenta would lead to profuse hemorrhaging, requiring emergent hysterectomy to preserve the mother’s life. Now, placenta accreta can be diagnosed with an ultrasound during pregnancy.

With early diagnosis, lifesaving plans can be put in place to minimize the risks to you and your baby throughout your pregnancy and delivery.

No treatment is available during the pregnancy, but several treatment options are available during delivery.

Our team at the Placenta Accreta Spectrum (PAS) Center can help to devise a plan of management that will best suit your case and be the safest for you and your baby.

Once you are diagnosed with placenta accreta, you will meet with all the team members and understand the step-by-step process until your delivery, as well as have contingency plans for any emergency delivery.

Our multidisciplinary team of experts includes your maternal-fetal medicine specialist, gynecological oncologist, anesthesiologist, urologist, radiologist/interventional radiologist, critical care, Ryder Trauma team, neonatologists, transfusion medicine specialist, and Center for Bloodless Surgery. The team has extensive experience with placenta accreta spectrum and have treated many patients that have cases similar to yours. The multidisciplinary team at UHealth/Jackson has been working together for several years and has extensive experience in cesarean hysterectomy and uterine preservation surgery – a procedure in which the placenta is left inside the uterus (“in situ”) and your uterus is saved.

At UHealth/Jackson we have an established Placenta Accreta Spectrum (PAS) program with standardized protocols and proven outcomes. Our patients deliver at a state-of-the-art facility with access to critical support resources, including 24/7 blood bank and transfusion services. In addition, at UHealth/Jackson a placenta accreta laboratory is in place with extensive translational innovative research in the field.

Most often the recovery is similar to a cesarean section. You’ll most likely stay in the hospital for three to five nights after delivery. Very rarely, some women will need to stay in the intensive care unit for a day or two to help them recover from blood loss.

The risks of placenta accreta can be serious and can expand beyond the mother to the newborn. If an emergency C-section is required during the pregnancy, the baby might be delivered prematurely and require care in the neonatal intensive care unit (NICU) at Holtz Children’s Hospital. Risks for the mother can include:

• Damage to the uterus and surrounding organs
• Loss of fertility due to the need of a hysterectomy (removal of uterus)
• Excessive bleeding that requires a blood transfusion
• Death

Delayed interval hysterectomy is a treatment plan that involves delivering the baby and leaving placenta inside the uterus (“in situ”) with expectation to perform hysterectomy at a later time, when the risk of blood loss and tissue damage may be decreased. While still considered investigational, this approach can be a strategy for placenta accreta cases with severe invasions.

We will do our best to preserve the uterus, however, most cases of accreta require hysterectomy. In rare and individualized cases, conservative and expectant management may be considered. Conservative management is when a portion of the placenta is removed, expectant management is when the placenta is left inside the uterus. According to the American College of Obstetricians & Gynecologists (ACOG) and the Society of Maternal Fetal Medicine (SMFM): conservative management or expectant management should be considered only for carefully selected cases of placenta accreta spectrum after detailed counseling about the risks, uncertain benefits, and efficacy and should be considered investigational.

Yes, most women are able to produce breast milk after an accreta delivery, even if it involved a hysterectomy. Our lactation consultant can assist you in this process. Keep in mind that placenta accreta moms often have many factors that can make breastfeeding more challenging (premature baby, blood loss at delivery, etc.), so be kind to yourself and know that we are here to help you in any way possible.