Tuesday, 10 April 2018

Problems With My Placenta.

I've said it before, Mr A and I went into Jonah's pregnancy naively thinking it would be pretty much the same as Violet's. How wrong we were. If you've been keeping up to date, you'll know I had issues from the get-go and my pregnancy was far from plain sailing. I did promise a post with a little more information about the two conditions I was diagnosed with, which ultimately led to a stillbirth and emergency hysterectomy. Bearing in mind, there is very little information on Placenta Percreta, particularly in the UK, so I will write as I interpret the information I received from my consultant. But lets start with Placenta Previa as this was the initial diagnosis I was given.

Placenta Previa (low-lying placenta)

At 18 weeks, I was diagnosed with partial Placenta Previa. Which, in a nut shell, means the placenta is partially covering the internal os (or the babies exit, as I like to call it). This is a pretty common diagnosis, particularly before 20 weeks. Often as the baby grows, the uterus stretches and in turn moves the placenta up and away from the internal os and no longer causes any issues. If previa is present at 20 weeks during the scan, an appointment will be made for around 32 weeks to determine if the placenta has moved out of the way and therefore a vaginal delivery is safe. 

In my case, I'd already made up my mind and was opting for a planned c-section but still would have required further scans to see where the placenta was and where it would be safe for an incision to be made. 

When I was scanned on the 29th January, after the first large bleed at home, I was told that I now had Complete Placenta Previa, meaning the internal os was completely covered by the placenta. The CPP was now thought to be the cause of my bleeding. Previa can cause painless bleeding throughout pregnancy and in my case contributed to an antepartum haemorrhage. Previa is also a risk factor of Accreta. 


Image from here 

Placenta Accreta

Okay, so this is a little more complicated to explain and as I said before, there is very little information on the condition in the UK. Accreta is broken down into three stages; Accreta, Increta and Percreta. Confusingly, Accreta is also the umbrella term for all three conditions. 

The most common is Accreta, and is 75-78% of cases. From my understanding, this is where the placenta embeds deeply into the uterine wall but does not move through the wall. I have attached a little diagram to explain more clearly. 

The second most common is Increta, which accounts for 17% of all Accreta cases. This is where the placenta attaches and begins to move through the uterine wall, but does not break through the other side. 

Finally, the least common and most severe form of Accreta is Percreta - the diagnosis I was given. Percreta accounts for 5-7% of all cases and is where the placenta moves completely through the uterine wall and out of the other side. In lots of cases, it then attaches itself to nearby organs, generally the bladder or bowel. My placenta was attached to my previous c-section scar and the outer lining of my bladder. My surgeon explained, in all cases of Percreta, a hysterectomy is generally required and if my pregnancy had continued, I would have had to have a section of my bladder removed. 

Image from here 

The risk increases after every caesarean delivery. Any damage to the uterine wall, gives the opportunity for the placenta to embed deeply and Accreta to occur. The risk of Accreta after a c-section delivery, is still small at around 0.4-0.8% risk - but it's still a risk and it does happen. A previous section, combined with placenta previa, increases the risk further to 3% and continues to increase after every c-section. 

I was very, very unlucky. This isn't something that happens to everyone with a previous section delivery, but it's something women need to be aware of. From the reading I've done, I had all of the warning signs, yet Accreta was never once suggested. If you have had a previous section, have a diagnosis of previa and are actively bleeding, the question needs to be raised - could this be Accreta?

As I've said, I'm no expert on the condition, but I really hope just talking about it can help prevent diagnosis being missed. Accreta doesn't always end the way my pregnancy did, again I was unlucky, but it does pose lots of risks to mother and baby. Accreta is life-threatening, yet it's not talked about and I really need to change that, one blog post at a time!

If you want anymore information, here is the link to the Royal College of Obstetrics & Gynaecologists guidelines on the conditions. 

Katie xx


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2 comments

  1. Thank you for the explanation, Katie! I have never heard of placenta accreta before. Do you know how can that be diagnosed? Can it be seen on a normal scan? Also, if diagnosed early is there anything that can be done to prevent going from accreta to percreta, if that is even the way it works... I'm sorry if it is too many questions I was just curious about the subject.

    xx Joana

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    1. It can be diagnosed, but unfortunately in my case it wasn't. I had 9 ultrasound scans in total and it wasn't seen, however I do know of ladies that have been diagnosed on a normal ultrasound. In my case, I should have been referred for an MRI scan at 28 weeks.
      I don't believe anything can prevent accreta developing further, I think it's all just down to the way the placenta has grown and embedded right from the start of the pregnancy. xx

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