Impairment of Placental Adhesion – In a placenta accreta, the tissue of the placenta not only joins the uterine lining but grows into the muscles of the uterus. After birth, therefore, the placenta can not break loose on its own, resulting in heavy bleeding.
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The placenta – supply center for the baby
The placenta (mother cake) consists of both maternal and child tissue. It forms during the first weeks of pregnancy when embryonic tissue – the so-called trophoblasts – grows into the uterine lining. After birth, she then ensures the care of the baby and the removal of its metabolites.
Also, it produces important hormones for the preservation of pregnancy, influences the immune system of the mother so that rejection reactions to the baby are excluded and protects the child through the placental barrier from many pollutants and germs. During pregnancy, the placenta also grows. At the time of birth, it weighs about 500 grams, is two to five inches thick and has a diameter of about 20 centimeters.
Unlike all other human organs, the placenta must not only control its growth from the beginning but at the same time manage its functioning according to the needs of the child. After birth, it usually dissolves independently from the uterine wall and is driven out as a so-called afterbirth by the aftermath.
The blood vessels that connect the maternal body to the placenta close – the healing and recovery phase has begun.
How is a placenta accreta created?
In the case of a placenta accreta, the development of the placenta is disturbed in one important dimension right from the beginning: it not only infiltrates the uterine lining but also connects to the muscles of the uterus. The uterus is – like all hollow organs – composed of three tissue layers: Their outer layer – a smooth, shiny coating – is called medical periphrasis or serosa, in the middle is the smooth muscle of the myometrium, inside the uterine lining or endometrium.
During pregnancy, the uterine lining is also referred to as decidua or decidua – if a placenta accreta is present, doctors also say that placental tissue has permeated the decidua basalis:
- In 75 percent of all cases, there is a “classical” placenta accreta. The entire placenta or parts of it have penetrated through the decidua to the myometrium, but are grown into the muscle tissue only to a relatively small extent.
- With placenta increta – 20 percent of all cases – placental tissue grows to a greater extent into the myometrium.
- A placenta percreta occurs in five percent of all affected women. The tissue of the placenta has broken through the outer shell of the uterus and proliferates in other organs, especially in the bladder.
As a result, the placenta can not separate on its own; the blood vessels cannot close. A placenta accreta causes an open wound after birth, which can cause significant blood loss.
Causes of a placenta accreta
Doctors associate the increasing frequency of placenta accreta with the increase in cesarean births. Other surgical interventions on the uterus and uterine anomalies also favor their development. However, this anomaly can also arise without such preconditions.
Often it is also associated with a placenta previa. This is a deep approach of the placenta, in part, the organ partially or wholly obscures the cervix.
Symptoms and prenatal diagnosis
During pregnancy, a placenta accreta often causes no symptoms. Especially in the last third, some women may experience vaginal bleeding, which always requires immediate medical attention – in this case, your gynecologist will always consider the possibility of a placenta accreta and a placenta previa and examine you accordingly. A placenta accreta is usually discovered during ultrasound examinations during pregnancy.
Dangers for the baby or a lack of care of the child are initially not connected. However, if it comes before the calculated date of birth to very heavy bleeding, but these can cause the pregnancy must be terminated prematurely. In general, however, this concerns a time when the baby is already mature and thus safely viable.
What treatment options are there?
If the presence of a placenta accreta is known before birth, the mother’s doctors will almost always recommend a cesarean section to minimize risks to the mother and child – due to heavy bleeding or delayed labor. Also, if there is a placenta previa, the need for cesarean section often results from both diagnoses.
Also, a placenta accreta usually requires a procedure even with a natural birth: The placenta is, in this case, solved manually, often a curettage (sclerosis of the uterus) is necessary. In the case of a not too pronounced placenta accreta, natural birth is still possible, in principle, if a placenta praevia does not close the birth canal. In the case of placenta increta or percreta, there is no alternative to cesarean section.
What consequences does a placenta accreta have for later births?
Often, women who have already had a placenta accreta will be advised to have a Caesarean section right from the start with the following pregnancies – but the problem does not necessarily have to be repeated in the next pregnancy. During the ultrasound examinations, the doctor will pay particular attention to the presence of a placenta accreta or other placental anomalies (placenta praevia). If everything is “OK” there is no need for a Caesarean section.
- A placenta accreta is a disorder of placental adhesion. The tissue of the placenta not only connects to the lining of the uterus but grows – in varying degrees of severity – into the muscles of the uterus.
- An unrecognized placenta accreta is especially dangerous during childbirth because the placenta can not separate on its own in this case, which can lead to delayed birth and severe bleeding.
- In the case of a placenta accreta, doctors usually recommend cesarean section. Natural birth is possible in light forms, but placenta anomaly is usually required after surgery.
- In later pregnancies, there is a higher risk of recurrence of a placenta accreta, but inevitably such a recurrence is not.