Placental accreta, increta and percreta

The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. Normally, the placenta grows onto the upper part of the uterus and stays there until your baby is born. During the last stage of labor, the placenta separates from the wall of the uterus, and your contractions help push it into the vagina (birth canal). This is also called the afterbirth.

Sometimes the placenta attaches itself into the wall of the uterus too deeply. This can cause problems, including:

  • Placenta accreta – The placenta attaches itself too deeply and too firmly into the uterus.
  • Placenta increta – The placenta attaches itself even more deeply into the muscle wall of uterus.
  • Placenta percreta – The placenta attaches itself and grows through the uterus, sometimes extending to nearby organs, such as the bladder.

In these conditions, the placenta doesn’t completely separate from the uterus after you give birth. This can cause dangerous bleeding. These conditions happen in about 1 in 530 births each year.

What are the signs of these placental conditions?
Placental conditions often cause vaginal bleeding in the third trimester. Call your health care provider right away if you have vaginal bleeding anytime during your pregnancy. If the bleeding is severe, go to the hospital right way.

How are these placental conditions diagnosed?
These conditions usually are diagnosed using ultrasound. In some cases, your provider may use magnetic resonance imaging (MRI). MRI uses magnets and computers to make a clear picture that may be hard to see on an ultrasound. The test is painless and safe for you and your baby.

How are these placental conditions treated?
When these conditions are found before birth, your provider may recommend a cesarean section (also called c-section) immediately followed by a hysterectomy. This can help prevent bleeding from becoming life threatening. A c-section is surgery in which your baby is born through a cut that your provider makes in your belly and uterus. A hysterectomy is when your uterus is removed by surgery. Without a uterus, you can’t get pregnant again in the future.

If you have a placental condition, the best time for you to have your baby is unknown. But your provider may recommend that you give birth at around 34 to 38 weeks of pregnancy to help prevent dangerous bleeding. If you want to have future pregnancies, she may use special treatments before the c-section to try to control bleeding and save your uterus.

If your provider finds these conditions at birth, she may try to remove the placenta in surgery to stop the bleeding. However, a hysterectomy is often necessary.

What causes these placental conditions?
We don’t know what causes these kinds of placental conditions. But they often happen where you have a scar from a surgery, like removing a fibroid or having a c-section. A fibroid is a tumor that grows in the wall of the uterus (womb). If you’ve had a c-section, you’re more likely than if you had a vaginal birth to have these kinds of conditions. And the more c-sections you’ve had, the more likely you are to have these placental problems.

Things that may make you more likely to have these kinds of placental conditions include:

How can you reduce your risk for placental conditions?
One way to reduce your chances for having these kinds of placental conditions in future pregnancies is to have your babies by vaginal birth instead of c-section. Have a c-section only if there are health problems with you or your baby that make it medically necessary. For some moms and babies, health problems make c-section safer than vaginal birth. But if your pregnancy is healthy, it’s best to stay pregnant until labor begins on its own. Don’t schedule a c-section for non-medical reasons, like wanting to have your baby on a certain day or because you’re uncomfortable and want to have your baby earlier than your due date.

Even if you’ve already had a c-section, you may be able to have your next baby by vaginal birth. This is called vaginal birth after cesarean (VBAC). You may be able to have a VBAC depending on what kind of incision (cut) you had in your c-section and your overall pregnancy health. Talk to your provider if you think VBAC may be right for you.

What are some other placental problems?
In some cases, the placenta doesn’t develop correctly or work as well as it should. It may be too thin, too thick or have an extra lobe. The umbilical cord may not be attached correctly. Problems like infections, blood clots and infarcts (an area of dead tissue, like a scar) can happen during pregnancy and damage the placenta.

Placental problems like these can lead to health risks for you and your baby. Some of these risks include:

  • You may have a miscarriage.
  • Your baby doesn’t grow as well as she should during pregnancy.
  • You may have bleeding at birth.
  • You may have a premature birth. This is birth that happens too soon, before 37 completed weeks of pregnancy.
  • Your baby may have birth defects.

Your provider checks the placenta after birth. Sometimes the placenta is sent for testing in a lab, especially if the baby has certain health problems, like poor growth.

Last updated January 2012

See also: Placental abruption, Placenta previa

Most common questions

What is mononucleosis?

Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.

You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:

  • Achy muscles
  • Belly pain
  • Fatigue (feeling tired all the time)
  • Fever
  • Sore throat
  • Swollen glands in your neck

If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.

There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

I had a miscarriage. How long should I wait to try again?

Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.

Are gallstones common during pregnancy?

Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.

©2013 March of Dimes Foundation. The March of Dimes is a non-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3).