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Treatments and drugs
By Mayo Clinic staffIf your health care provider suspects placenta accreta, he or she will work with you to develop a plan to safely deliver your baby.
In the case of extensive placenta accreta, a C-section followed by the surgical removal of the uterus (hysterectomy) might be necessary. This procedure, also called a cesarean hysterectomy, helps prevent the potentially life-threatening blood loss that can occur if part or all of the placenta remains attached after delivery.
A cesarean hysterectomy should be done at a hospital that has an intensive care unit and is equipped to handle complications, such as severe bleeding. Your health care team for the surgery might include an obstetrical surgeon, a pelvic surgeon and an anesthesiologist, as well as a neonatologist to treat your baby.
Your health care provider might recommend scheduling the C-section and hysterectomy as early as week 35 of pregnancy to avoid an unscheduled delivery. To evaluate the maturity of your baby's lungs, your health care provider might test a sample of amniotic fluid — the fluid that surrounds and protects a baby during pregnancy. This test is known as maturity amniocentesis.
During the C-section, your health care provider will deliver your baby through an incision in your abdomen and a second incision in your uterus. After delivering your baby, your health care provider or another member of your health care team will remove your uterus — with the placenta still attached — to prevent severe bleeding.
A hysterectomy ends your ability to become pregnant. If you had planned to become pregnant again in the future, consult your health care provider.
Rarely, the uterus and placenta might be allowed to remain intact, allowing the placenta to dissolve over time. However, this approach can have serious complications, including:
- Severe vaginal bleeding
- Infection
- A blood clot that blocks one or more arteries in the lungs (pulmonary embolism)
- The need for a hysterectomy at a later date
In addition, limited research suggests that women who are able to avoid hysterectomy after having placenta accreta are at risk of pregnancy complications with subsequent pregnancies, including miscarriage, premature birth and recurrent placenta accreta.
If you're interested in uterine conservation, ask your health care provider if it's a possibility for you. If so, he or she can help you weigh the risks and benefits.
- Resnik R. Diagnosis and management of placenta accreta. http://www.uptodate.com/index. Accessed March 21, 2012.
- Weeks A. Diagnosis and management of retained placenta after vaginal birth. http://www.uptodate.com/index. Accessed March 21, 2012.
- DeCherney AH, et al. Current Diagnosis & Treatment Obstetrics & Gynecology. 10th ed. New York, N.Y.: The McGraw-Hill Companies; 2007. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=9. Accessed March 21, 2012.
- American College of Obstetricians and Gynecologists. Your Pregnancy and Childbirth Month to Month. 5th ed. Washington, D.C.: American College of Obstetricians and Gynecologists; 2010:373.
- Silverman F, et al. Management of the third stage of labor. http://www.uptodate.com/index. Accessed March 21, 2012.
- Jauniaux E, et al. Placenta accreta: Pathogenesis of 20th century iatrogenic uterine disease. Placenta. 2012;33:244.
- Marc I, et al. Mind-body interventions during pregnancy for preventing or treating women's anxiety (review). Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007559.pub2/abstract. Accessed March 26, 2012.
- Gielchinksy Y, et al. Placenta accreta - Summary of 10 years: A survey of 310 cases. Placenta. 2002;23:210.
- Wright JD, et al. Predictors of massive blood loss in women with placenta accrete. American Journal of Obstetrics and Gynecology. 2011;205:38.e1.
- Eller AG. Optimal management strategies for placenta accreta. BJOG: An International Journal of Obstetrics and Gynaecology. 2009;116:648.
- Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Wolters Kluwer Health Lippincott Williams & Wilkins; 2008:1.
- Society for Maternal-Fetal Medicine. Placenta accreta. American College of Obstetricians and Gynecologists. 2010;203:430.
- Frequently asked questions. Special procedures FAQ 008. Hysterectomy. American College of Obstetrics and Gynecology. http://www.acog.org/~/media/For%20Patients/faq008.pdf?dmc=1&ts=20120326T1355412038. Accessed March 26, 2012.
- Gielchinksy Y, et al. Perinatal outcomes of pregnancies complicated by placenta accrete. Obstetrics & Gynecology. 2004;104:527.
- Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. March 28, 2012.
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