What Is Placenta Accreta?

This serious pregnancy condition happens when the placenta attaches too deeply into the uterine wall. Experts explain causes, symptoms, and treatment.

Medically reviewed by Kiarra King, M.D.

During pregnancy, the placenta typically attaches itself to the endometrium or the inner lining of the uterus. But in rare cases, the placenta can go even further into the uterine wall, causing a serious pregnancy condition called placenta accreta. The condition can be life-threatening.

Experts explain the causes, symptoms, and treatment of placenta accreta.

What Are the Different Types of Placenta Accreta?

“There are three variations—accreta, increta, and percreta—which are based on the depth/extent of invasion into the uterus,” explains Lance R. Bruck, MD, OB-GYN, a chairman at Jersey City Medical Center in Jersey City, New Jersey. The complexity of managing placenta accreta spectrum increases with deeper invasion.

• Accreta: This is the most common type and it’s a superficial invasion into the myometrium (muscular layer below the endometrium).

• Increta: This indicates deep invasion into the myometrium.

• Percreta: This is the most serious case and involves invasion through the uterine musculature, potentially extending into nearby pelvic organs, such as the bladder.

How Common Is Placenta Accreta?

Placenta accreta affects 1 in 533 pregnancies. Although it’s rare, it has increased in recent decades. “The prevalence has been rising due to the increased number of Cesarean deliveries performed over the past three decades,” says Dr. Bruck.

Risk Factors for Placenta Accreta

Placenta accreta can’t be prevented. The biggest risk factor for placenta accreta is prior C-section, says Kelly Culwell, MD, board-certified OB-GYN in San Diego, California. The C-section scar area is thinner than the rest of the uterine wall and if the placenta attaches over the area of the scar, there is an increased risk that the placenta will grow into the wall of the uterus.

Other risk factors include:

• Prior uterine surgery

• Being over the age of 35

• Prior postpartum endometritis

• Fertility treatments

• Placenta previa or when the placenta covers the opening of the cervix

Are There Symptoms of Placenta Accreta?

There are usually no symptoms until delivery when the placenta is not able to detach normally from the uterus, says Dr. Culwell. “This can lead to severe hemorrhage and even death after delivery,” adds Dr. Culwell.

This is why detecting placenta accreta early via ultrasound is critical.

Complications of Placenta Accreta

Placenta accreta can be life-threatening, and can also lead to:

• Preterm delivery

• Excessive bleeding before, during, or post delivery (this is especially true is placenta previa is also present)

• A hysterectomy, or the surgical removal of the uterus, may be needed to avoid severe blood loss

How Is Placenta Accreta Diagnosed?

Placenta accreta is usually diagnosed in the second or third trimester through a combination of patient history and diagnostic imaging.

“Ultrasound is commonly used not just to measure fetal size but also to identify placental location,” says Dr. Bruck. “Specific ultrasound findings can indicate the presence of conditions like placenta accreta. MRI can also be utilized to assess the invasiveness of the placenta further.”

Early diagnosis is critical in ensuring the best outcome for the birthing parent and baby. A pregnant person should inform their provider about prior uterine surgeries during the initial prenatal care visit. If a health care provider suspects placenta accreta spectrum, you should be referred to a specialized center for care and delivery.

Placenta Accreta Treatment

When diagnosed prior to labor and delivery, a person will be monitored closely throughout their pregnancy. A C-section will be scheduled and typically performed between 34-36 weeks unless complications start earlier, explains Dr. Culwell. A health care provider may try to save the uterus if a patient hopes for a future pregnancy.

In severe cases, though, a hysterectomy may need to be performed at the same time as the C-section. If the placenta has grown into the bladder or other structures outside of the uterus, other procedures, such as a partial cystectomy (removing part of the bladder) may also be required.

Different approaches of treatment, including removal or the placenta or uteroplacental tissue without removing the uterus, have also been performed depending on a patient’s situation. A 2018 study found removing the placenta and inserting a Bakri balloon (an intrauterine device inserted to temporarily control and reduce of postpartum hemorrhage) helped prevent a hysterectomy in 84% of patients.

The bottom line is placenta accreta is a pregnancy condition that can be life-threatening. While it can't be prevented, treatment for the condition should take into account the risks, benefits, and efficacy.

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