What is abnormal placentation?
Abnormal placentation, also known as placenta accreta, occurs in about one in 500 births and refers to a condition where the placenta grows deeply into the wall of the uterus. With placenta accreta, the placenta fails to separate during delivery, which can cause severe hemorrhage (bleeding).
Northwell's OB/GYN specialists have expertise in both the diagnosis and management of abnormal placentation. Diagnosis prior to delivery is essential, as untreated abnormal placentation (placenta accreta) can be a life-threatening condition for a mother if it goes undiagnosed prior to the birth of the baby. Our team offers advanced care to make the diagnosis as early as possible and provides individualized treatment options to manage the condition.
How is it diagnosed?
There are generally few warning signs of placenta accreta, but women with placenta previa may experience painless bleeding during the third trimester. If you experience this, an evaluation including an ultrasound is done so the diagnosis can be made. If you have a low-lying placenta or placenta previa identified on ultrasound and also had uterine surgery in the past, our experts will perform a detailed ultrasound examination during the third trimester to assess your risk for placenta accreta.
Scheduled delivery before the onset of labor by an experienced multidisciplinary team is the treatment of choice for pregnancies complicated by placenta accreta. As soon as the diagnosis is made, it's very important to schedule the delivery, which is usually planned four to six weeks before your due date. A contingency plan for emergencies is also developed. The location of your delivery is a key planning element. It is recommended that you deliver at a tertiary perinatal center that has an equipped blood bank, experienced anesthesiologist, urologist, interventional radiologist and an obstetrician/pelvic surgeon to perform the delivery. A neonatal unit prepared to care for a premature baby is essential. Our experts will provide recommendations on where to go if you need this type of delivery.
As a patient with placenta accreta planning delivery, it will be important to discuss with your doctor the likely need for a blood transfusion at the time of delivery. In addition, you will be encouraged to maximize your blood count through iron stores to avoid going into delivery anemic.
During planning, our team will discuss various treatment options with you. The recommended management for placenta accreta is cesarean hysterectomy. If you wish to retain your fertility, our experts will share information about conservative management. This means that the placenta will be left inside the uterus after the baby is delivered. You will be counseled about the specific risks associated with this approach. Our team of experts will work with you to make a plan that is best suited for you and your family to manage this condition.