anyone had placenta accreta/morbidly adherant placenta?

[GothMummy]

Hi

Im looking for information/experiences on placenta accreta/morbidly adherant placenta. Its possible that this condition has been detected on my scans, and my consultant has so far been unable to rule it out. However, i have another scan in a few weeks to try to ascertain whether it is or not. I dont have any of the risk factors (never had surgery to the womb, first birth was natural etc) so he said it would be very unusual.

However, its hard to find information on this topic. If anyone has had this could you tell me, was removal done under GA or with an epidural (Im very frightened of undergoing a traumatic surgery that I am awake for). Did it result in hysterectomy or could the placenta be removed? Was it done vaginally or abdominally?

If it was a hysterectomy, did they leave the ovaries? If not, were you given hormone replacement tablets?

If my birth results in a hysterectomy, am I correct in thinking that I wont be able to breastfeed (dont the hormones that produce milk come from the ovaries??).

And finally, has anyone actually had this condition detected on a scan?

Thanks very much in advance for any information you can give.

This was flagged as a possibility for me but I don't have it (currently 35 weeks). I would say it is quite unusual for accreta/morbid adherence to occur without previous surgery - often it happens when the placenta grows into, and sometimes through, a caesarean scar - but it's not impossible. Accreta can cause complications during delivery as the placenta can fail to detatch, which throws up the risk of haemorrhage. As you say, hysterectomy can sometimes be the only means of removing the placenta in this instance and therefore stabilising the bleeding. However, there are cases where morbid adherence of the placenta occurs and hysterectomy is not necessary so there is no hard and fast rule. It is difficult to guage accreta or morbid adherence via ultrasound scan, although very experienced sonographers can be quite precise. However, if there is still uncertaintly then the only way to determine whether you have accreta for certain is via an MRI scan. Has your consultant suggested this? It would give you clarification and peace of mind, which I think is important. Plus if the MRI rules out accreta then you are spared unnecessary abdominal surgery via caesarean if this is not your preference.

As to your surgical options, my consultant told me that if I did have placenta accreta then caesarean section was my only option. I don't think it was possible to remove the placenta vaginally in such instance as they need a full picture of the uterus and they can only obtain that by opening it up. It carries far less risk and then can a) manage any bleeding that might occur, and b) make an informed decision on whether the uterus needs to be removed.

If a hysterectomy is necessary I'm not sure if they would use GA or epidural. It may well be they would have to implement a GA on top of the epidural during the operation if problems presented theselves, but equally you could ask for a GA if that was your strong preference. The only issue with a GA is that it makes the recovery physically harder as you have to recover from the anaesthetic. Plus, you miss the birth of your baby. However, if this was planned you could arrange for photographs/video to be taken of the birth itself so that you'd have a record afterwards.

If you did have to have a hysterectomy then I doubt that they would remove your ovaries as there would be no clinical need as the placenta would not be attached to them (only the uterus). If they left the ovaries then you would not experience menopause following your hysterectomy as you would still ovulate on a monthly basis. As for breastfeeding, I doubt there would be any impediment following a hysterectomy as they can and will give you synthetic hormonoes to trigger your milk production. You might find your milk was slightly delayed in 'coming in' by a day or two, but this is not a certainty and has no long-term impact on feeding.

Sorry this is all a bit vague - I know there are some people on here who have had hysterectomy due to accreta so hopefully they'll answer your question in more detail. My information is based only on the 'what if' outlines I was given by my consultant as I waited and worried to find out whether I had accreta or not. In my case, a scan with a specialist sonographer at the Fetal Medicine Centre was able to pinpoint that I was at least 1cm clear of my previous c section scar so not at risk of accreta. Had it been closer I would have been sent for an MRI to establish the exact location.

Hope this helps.

Thank you very much for taking the time to reply to my question, I really appreciate it. I have heard one of my healthcare professionals mention an MRI but i cant remember if it was my consultant or the midwife. My next scan is to be done by my consultant when I am 28 weeks, I am currently 25 weeks. I have been reluctant to ask my consultant these questions as I am very concious of wasting his time if there is no accreta, or of "jumping the gun" if theres nothing to worry about anyway. Im a bit in awe of the consultant and also trying to be really sensible/brave about it all and not be alarmist front of my husband etc.

The positive thing about worrying about all this is that I am truely and deliberately enjoying/savouring this pregnancy in a way that I really didnt with my first, because I am aware that there is a chance it might be my last! Though the plan was to have more children if possible.

My preference would be for a natural birth - my first was a home birth with minimal gas and air. Im certainly not begging for a cesearean if I can avoid it at all.

Regarding breast feeding, I do think that not being able to breast feed would upset me greatly, (I felt it was the one bit about mothering a baby that I was actually any good at last time!) so thanks for the "heads up" that there may be a possibility of hormones to kick start breast feeding if I have a hysterectomy.

Also, I thought that placenta accreta always meant a hysterectomy - so thanks for informing me that sometimes they can remove the placenta without taking the uterus.

Thank you again. Im glad that for you the condition has been outruled :)

Hello, I had placenta accreta and I am 3 weeks post op from my hysterectomy (uterus & cervix only removed). I will tell you my story, maybe it will help...I dont know but here goes..

I had my son on Jan 31st 2011, it was a vaginal delivery and everything went fine. The doctor did have a hard time removing the placenta and I had to push more to get it out then the baby himself. The doctor looked the placenta over throughly and said that everything was there and everyone went about their business.

He was my 4th baby and each one of my babies have been vaginal deliveries. Well after I left the hospital my bleeding seemed normal up until about a week and half after delivery. I started bleeding VERY VERY VERY heavy, hemmorraging and huge clots. So I went in to the doctor and they did an ultrasound and found that there was a lot of placenta still left so my doctor ordered an outpatient D & C surgery to remove it. After surgery he said he thought it was successful. Well, I go home to recover and the bleeding was suppose to get better and it did for a few hours, then started up again. It would vary from heavy to mild and clot and back and forth...for days. Finally 5 days after the surgery I was feeling so drained and could tell that I had lost so much blood that something had to be done so I went back into the doctor's office and he came in with the pathology report from the D & C and it came back as Accreta. From my understanding, that is the only way they can know for sure if it's accreta is from actually testing the tissue. He was already going to talk to me about my options, A.)go in and do another D&C and try to get more placenta out but that wasn't 100% because there was a chance that the tissue that had now become one with my uterus would still be there and later cause infection because it was dead tissue left inside or go in and remove more tissue and then since it's imbedded with the uterus it in turn exposes more blood vessels and causes more bleeding and can also be dangerous and then plan B)Hysterectomy. Well, I didn't want anymore kids but also did want a hysterectomy but my health was #1 and so we went with plan B.

I had a laproscopic vaginal assisted. I am not gonna lie it was HORRIBLE, recovery has been so hard because I have a newborn and a 2 yr old and 2 older kids that really do for themselves but I am also only 32 and not ready to "maybe" go thru menopause. I still don't know what is going to happen because it's all still new to me and I am trying to look up stuff about it also. My recovery has been so slow and they tell me that I should be healing faster but I also have 2 little ones to take care of. I am making more progess and starting to feel better but now I have this weird lower back pain. It's all kinda scary and I had no idea what side affects if any to expect because everyone is different. It did set me into full on post partum depression with anxiety attacks that landed me back into the hospital. I am really not trying to scare you but I am just giving you the REALITY of my case and wished I had known what COULD happen. I hope you're situation is/was better than mine and make sure they do tests and get another opinion before doing something so life changing.

It sucks that it had to happen with it being so rare but yes, I am also one of the ones that it happened to without having a csection...crazy!

GL!!!

Oh and I was NOT awake during either surgery, I was under General. The Hysterectomy is MAJOR SURGERY so you will be in the hospital for a few days if you have to have one. Yes I breastfed and didn't affect milk production..hope that helps

Oh my goodness, Barbbie79 - thank you for taking time to reply to me. It sounds like you have had a truely horrible time and I am grateful to you for letting me know. Its better to be prepared than in shock afterwards!

No wonder you are not healing well with so many children to take care of :(

Im 33 so its scary to think of going through menopause at this age.

With my first birth I had some retained bits, (though inspection of the placenta at delivery said it was intact - but they were wrong!) a LOT of bleeding/clots/tissue passing for some weeks and subsequent infection that took a lot of antibiotics to recover (and OMG I felt so ill) from so I wonder if that is linked in some way to this question mark over accreta - as it sounds a bit similar to your experiences prior to the hysterectomy.

I do hope you recover soon.

Hi Gothmummy,

I had placenta accreta in Sept 2009 when I gave birth to my DD. It was not diagnosed prior to birth and I had a normal vaginal delivery. On attempting to deliver the placenta, the mw realised it wasn't going to come out. A consultant came to see me and decided it was placenta accreta, so I had surgery to remove the placenta.

This was done under GA, although I could have had an epidural. Fortunately, they were able to remove most of the placenta and I did not require a hysterectomy. Some of the placenta was retained and I was told to look out for heavy bleeding etc, but I didn't have any further problems.

I was glad that I had chosen to have a GA because (as you probably realise) the placenta is removed vaginally and I was very glad not to be awake during this procedure. Also, in my case, it took quite a long time to remove it, so would have been pretty traumatic.

I wanted to tell you that neither a hysterectomy nor a CS is always necessary.

I am pg again and hoping to avoid placenta accreta this time.

Good luck to you - hopefully you won't have it, but if you do, I wanted to let you know that it doesn't necessarily mean you'll have to have a hysterectomy.

i have today been told i probably have accreta with baby no 6, i have read up on this in the past as i had previa last time, feeling a bit panicy this arvo. i have read its better if the hysterctomy is planned

I had a retained placenta which was attatched to previous scar tissue but it was not accreta and was manually removed via spinal.
I am now currently pregnant with number 3, and my 20 week scan has shown a possible previa and increased risk of accreta due to my 2nd being delivered by EMCS.
I have to return for another scan at 34 weeks and will find out more then. I am very nervous and have googled and pooped. I have now decided it probably isn't a good idea to google or worry. But I am finding it very hard.
I hadn't allowed hardly any healing time from my section before I fell pregnant again and I am aware this may increase the possibility of accreta.

OP, definitely give this a read, it's well worth it (although scary in places, it has lots of good info).

www.rcog.org.uk/womens-health/clinical-guidance/placenta-praevia-and-placenta-praevia-accreta-diagnosis-and-manageme

Whoops not a clickable link, sorry.

www.rcog.org.uk/womens-health/clinical-guidance/placenta-praevia-and-placenta-praevia-accreta-diagnosis-and-manageme

Thank you everyone for your replies, its really helpful. at my recent scan the consultant said that he didnt think I had accreta, but he couldnt rule it out, so I was not advised to have a home birth (I wasnt planning on this anyway) but to have a hospital delivery, and to be set up with a cannular on admission to the ward as a precaution. He also wrote that if the placenta does not detach readily then senior medical personal should be immediatly involved (I was frightened that midwives might not realise and be tugging at it etc).

Hopefully and fingers crossed I wont face that, but currently this baby is breech anyway so I may end up in theatre anyway.....

that is a really good link barelyutterly im off to the consultant this arvo & now feel a lot more clued up !