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19 comments to Placenta accreta – a risk of cesarean section

  • MM

    This article is torturing me. I have a friend who was talked into a c/s with her first baby because “at 41 weeks nothing was happening down there”. And now she’s pregnant again, loves loves loves her OB, and I’m 99.9% sure she’s already scheduled. I really want to send this to her, but it will never come across the way I would want it to. Add to it, all of this coming from a girl who has had two c’s of her own…

    Like I said, torture.

  • [...] Posted by doulamama1 on August 3, 2009 This is a very good article from vbacfacts.com. [...]

  • I am with you on encouraging VBAC’s rather than another c-section for women who are good candidates for one.

    I also think it’s important for women that have had multiple c-sections to know that the risks for Placenta Accreta are low. Many women go on to have 4 or more c-sections without any problems at all, and yet I’ve met (and read about) women that have had accreta in a pregnancy after only 1 or 2 c-sections. C-sections don’t have to end a woman’s childbearing years early, but it is good to know the risks to make that decision.

    • Jen from vbacfacts.com

      Hi Morgan!

      According to Silver (2006), a four year study of up to six repeat cesareans performed on 30,000 women, there is a 2.13% chance of accreta and a 2.41% chance of hysterectomy during a fourth cesarean. In other words, 1 in 47 women will have accreta and 1 in 41 women will have a hysterectomy.

      Counter that with the rates in a first cesarean: 0.24% for accreta (1 in 417) and 0.65% for hysterectomy (1 in 154).

      The rates for accreta and hysterectomy dramatically increase as the number of cesareans increase.

      It’s also interesting to note that the rate of hysterectomy in a second cesarean (Silver, 2006) is the same as the rate of uterine rupture in a spontaneous labor after one prior cesarean: 0.4% (Landon, 2004). Both are the effective end of a woman’s fertility.

      Warmly,

      Jen

  • Jennifer

    I’m glad i found this. I am not even a week overdue and my ob is insisting on a c-section because I had one previously. I also had a vaginal delivery and feel like I’m being forced into having a c-section. I remember how long it took to recover from the c-section and how I couldn’t even hold my child for the first 2 hours. I don’t want to miss out on that again. Thank-you for this article!

  • Anna

    I think it is crucial for women to talk to their doctors about the potential risks associated with cesarean sections. It is also important to acknowledge the number of lives that have been saved by this procedure. Nothing comes without the potential for complications. With improved awareness, screening, planning and management, placenta accreta may have more promising outcomes.

    • Jen Kamel

      Anna,

      Many women and babies have been saved by cesarean deliveries. The problem is that many women and doctors have become so caviler about the risks of cesareans, especially multiple cesareans. This is one of the many variables that colors how doctors counsel women on VBAC vs. repeat cesarean.

      The unfortunate reality is that many women are interested in the option of a VBAC, but cannot find a provider. And these hospitals that claim they cannot adequately respond to a uterine rupture, and thus ban VBAC, must now contend with increasing rates of placenta accreta which is a medical emergency of its own right. They are exchanging one complication for another and they both can have catastrophic outcomes.

      Most women with prior cesareans are so heavily counseled on uterine rupture as a risk of VBAC that they happily consent to a repeat cesarean. However, if these women were informed on the risk of placenta accreta, and how the risk increases with each cesarean, they would probably give their options more thought.

      It’s practically common knowledge that uterine rupture is a complication that accompanies a trial of labor after cesarean. Why are women not equally informed on the risks of cesareans? I suspect it’s because VBAC counsels provided by care providers are often lacking and leave women with the impression that VBAC is excessively risky and repeat cesareans are safe. Really, women should walk out of those counsels understanding that there are real and rare complications that occur with each mode of delivery. They should understand that the risks of VBAC decrease after a successful VBAC, the risks of cesareans increase with each surgery (Mercer, 2008) and the risks of baby dying during a trail of labor after cesarean is almost the same as mom dying in a repeat cesarean (Landon, 2004).

      Warmly,

      Jen

  • lizzie

    What an eye opening article. I am a mother of 3 with 3 different birth experiences. My first was born via C-section b/c of fetal distress at 9.5 cm. Dr. could feel baby’s head but baby kept slipping back up birth canal (cord was wrapped around ankle) he was born almost blue, so I have no doubt the section was necessary. The OB told me I could not deliver via VBAC if I had another child b/c of risk.
    I did some research and when I became pregnant with my 2nd I was at a military instillation in TX, dead-set on a VBAC and and the Midwives there were amazingly supportive of a VBAC. I was told the hospital discourages C-sections unless medically necessary. I received an epidural at 6cm b/c of the uterine rupture risk and though labor slowed down I was able to have my baby vagionally. Though my daughter’s heartrate dropped just before birth the RNs said “oh, that is normal when baby is ready to come.” That was music to my ears!
    My 3rd child was born 3 months ago at a military hospital in Hawaii. I was told horor stories of the OB department where I was delivering, such as… ‘even though I had a seccessful VBAC with a baby a pound heavier than my first, I would have to have a c-section because they would be more comfortable.’ I told them that I would leave AMA and have the baby in the parking lot if I had to.
    I arrived in the middle of the night, no midwives on duty but fortunatly I had the best team a gal could ever wish for. C-section never even came up in conversation and the STRONGLY encouraged me to have a natural, unmedicated birth!!!
    Thank God for Midwives, OBs and nurses who believe in the VBAC and help you stand your ground when your world is spinning round and round!
    Thank you again for publishing such an educational article. A gal I know had to have a historectomy with the birth of her 2nd child due to plecenta accrate and the children were 7 years apart. SCARY!!!

  • My previous monthly period period began on Nov. 29 and lasted 4 days. It is now December 19th and I’m experiencing very light, brownish bleeding together with minor cramping. I have already been trying to get pregnant for three months’ now. Could this be implantation bleeding? If it is, in how much time could i complete a pregancy test?

    • Jen Kamel

      I’m not a medical professional, but if I were you, I would wait two weeks and take a pregnancy test. You are on day 20 of your cycle so if you have longer cycles, it could be implantation bleeding. If you have any concerns, I would contact your doctor for further information.

  • Mrs. Taylor

    I just gave birth to my daughter April 27, 2011. The doctors found during my c-section that I had placenta accreta. How likely is it to happen again? They were very surprised that I didn’t bleed to death or have to have my uterus removed. I wanted to have another baby, however, the doctors cannot guarentee that this won’ t happen again. Not to mention I have had 2 abortions over 15 years ago and now one c-section. Any advice would be soooooooooo helpful.

    thanks in advance

    • Jen Kamel

      Mrs. Taylor,

      Placenta accreta is very serious. The risks of maternal mortality and hysterectomy are high. You can diagnose accreta during pregnancy via ultrasound although a MRI is more definitive.

      There is a 10%-25% rate of accreta recurrence according to this article: . (I’m sorry that I don’t have the time right to look up medical studies on this.)

      Here is how Dr. Bob Resnik at the University of California San Diego approaches accreta:

      At 18 weeks, almost every pregnant woman undergoes fetal anatomy ultrasound. At that time, the location of the placenta should be ascertained, and if the patient has risk factors, the diagnosis can be made with accuracy, by very specific ultrasound findings, about 80% of the time, and can be confirmed with MRI findings.

      If a placenta accreta diagnosis is made, the patient should be counseled that a caesarean section hysterectomy is the most appropriate therapeutic modality. Blood and blood products should be available, and sufficient surgical expertise should also be available to do what may at times be a very difficult and vascular hysterectomy. The role for conservative management is really very limited, and usually only appropriate when the accreta is in the fundal portion of the posterior wall of the placenta. We generally recommend delivery be done at 34-35 weeks after the administration of betamethasone to accelerate fetal organ system maturation.

      Best of luck! :)

      Warmly,

      Jen

  • Valerie

    Jen,
    I am currently 29 weeks pregnant with di/di twins. Baby a was a fetal demise at 19 +4 weeks. I also have complete placenta previa with twin A. At my last ultrasound they said the placenta had shrunk and become calcified which could act like an accreta? Apparently I will be requiring a csection of which I am terrified. What are the odds of having to have a hysterectomy?

    • Jen Kamel

      Valerie,

      I’m so sorry. I do not know off-hand the percentage of women with accreta who have hysterectomies, but I recall reading somewhere that it is high. You can read more about accreta here. Also, consider joining the VBAC Facts Community as one of the medical professionals there may be able to give you additional information. Sorry I can’t be more help!

      Warmly,

      Jen

  • Hello,
    Thanks to everyone for your posts. My question is this: If a c-section scar does not allow a placenta to receive proper blood supply, is there any way to reverse this? There are several methods of increasing blood flow to the uterus (fertility massage, fertility cleansing herbs, acupuncture), but does this blood increase in/through scar tissue as well? Or, is a scar permanent dead tissue? There are also potent systemic enzymes which claim to reduce a c-section scar, but do they simply erase the fibrin on the outside of the scar? Or, do they dissolve excess fibrin IN the tissue of the scar, thus allowing development of new vessels, and creating normal blood flow again? Thanks for any expertise!

    Nora

    • Jen Kamel

      Nora,

      I shared your question here. Follow that thread and hopefully some medical professionals will share some knowledge!

      Warmly,

      Jen

  • Lisa

    So I’ve been reading all this stuff about vbacs… We are expecting #2 which we are very excited about. My first was a c-sec… My paperwork mentioned CPD. I’ve been told the hospitals around here say they do vbacs and then around week 34 tell you no. Found a real midwife with 20 years experience (is known for vbacs). Husband and I have talked with her and she thinks we would be successful in a home birth. She doesn’t seemed concern with the CPD… What are your thoughts? I’m so torn on which way to go! I did my first labor all natural until my son would not fit ( was 10lbs, 1oz). What are the chances this will happen again? My OB basically said no to vbac. Any advice?

  • […] the most serious is placenta accreta,[19] a serious, life-threatening condition, for which the risk, by the fourth Cesarean, is a […]