PLACENTA ACCRETA - Can anyone shed any light on this?

[MonicaFree]

I'm 20 wks + 1 with second DC. Didn't have a nuchal fold test at my 1st scan (in Edinburgh so not offered it) but two weeks ago my bloods came back with hormone results giving me high risk of Downs. I agreed to an amnio and although the results for Downs have come back clear, the scan done during the amnio seemed to suggest I have placenta accreta. (They didn't actually tell me this at the time, I just found out when I had a bleed on Boxing Day and was admitted to hospital for observation overnight. The consultant asked if I knew why I was booked in for another scan and basically told me it was because I might have to have a hysterectomy with my c-section. )

I've now spoken to my midwife and done a bit of research on accreta and I'm getting quite scared. Actually, I've gone from shock to terror as I realise that the worst thing isn't me not having any more children but me haemorraging to death. Gulp.

Anyone with any experience of accreta? I'd be really grateful to hear it. Thanks.

Fruitful- Thank you so much for posting. I realise over the last few days I've lost sight of how nice it will be to have a (hopefully) healthy baby at the end of this. The intervening bit is just seeming a bit overwhelming. It's great to hear that you and your baby are fine. I'm not sure when/whether I'm going to be admitted to hospital but I'd love to hear how you coped - I'm dreading being away from DS and DH. (Especially as DH only knows how to cook fish fingers and omlettes.)

tsom - you sound way calmer than me so I shall take inspiration from that. I'll post after I've been for this appointment with the consultant radiographer on Wednesday. I've been told she's totally brilliant at her job so I'm pinning my hopes on getting more information then. I really can't seem to find much in the pregnancy books.

Hi treedelivery - scan Wednesday at 11.30. (Thanks again for supportive posts!)

Good luck tomorrow Specie.

Do you have placenta praevia as well or just accreta? Because the hospital admission thing is to do with the praevia - placenta starts to detach and you start bleeding, a lot, very suddenly - so best to be in hospital when it happens. The issue with accreta is that the bit of the placenta thats 'accreted' (almost certainly not a word!) won't detach. So it's not actually a problem till after you've had the baby.

Some info on the RCOG site

Advice on how to survive the antenatal ward; right now, train your dh to look after the house and your son. Work out 7 days of meals that he can cook, if cooking is not his thing. And get your house utterly organised - so when your dh phones and says "ds has outgrown all his trousers and what things do you need me to bring in for you tomorrow?" you can remember where everything is in your house and give him specific instructions. Also do all the baby shopping/preparation now! And start being very nice to your lovely in-laws.

I'll check back tomorrow - no point typing loads of advice if they tell you that you haven't got it.

Fruitful, thanks. Yes, placenta low and anterior - that much they are certain of - but not covering cervix, I think. The big worry seems to be that the placenta has attached to my scar from my previous c-section and that I may have additional accreta. It all seems a bit unreal.

Found this on the BBC in an article: "If someone has a low placenta on a scar, that's a dangerous situation and one of the most frightening in obstetrics "
Professor Andrew Shennan.

Otherwise cannot find very much reliable info. I have tonnes of pregnancy books and none of them mention accreta, so these mumsnet posts are very much appreciated. I'm off to check your link now.

Yay, yay, yay!! Just found this in the link: 'Conservative management of placenta praevia accreta can be successful and can preserve fertility. This
can involve a number of different management strategies, which are outlined below, but precise
recommendations are outside the scope of this guideline.'

OK, in amongst all the bloody stuff it ain't much - but it's a chink of light and I'm taking it!

Hang in there. Doctors are naturally pessimistic I find. But a 50% chance of a hysterectomy is a 50% chance of not having a hysterectomy!

The chink of light in the hospital-stay aspect is that when you get out with your baby, you'll be coming home to a dh who completely understands why your job as a mum is difficult.

Will be waiting to hear about scan - although it's a mad house around here so I will be back today sometime. Hope you get the results reviewd at the time and don't have to go back to clinic.

Hi SpSp. Hope the scan went well.

Starting to worry that they didn't let you home ...

Hmm....

Oh no, I'm home! This is my first opportunity to post since yesterday. Sorry!

I thought the appointment went really well - so much better than I'd hoped. I've still got the placenta praevia over my c-section scar but the radiographer was soooo much calmer than my midwife or obstetrician. She spent about 20 minutes looking at the placenta from every possible angle and said that both my uterus wall and my bladder looked in tact. Also, from what she could see she believed that the placenta would separate from the uterus ok but I'm to be monitored in case that changes, which it could as the placenta is sort of pushing out at the bottom left of my womb, but now I'm really just being seen like they would anyone with praevia.

DH and I were walking on air afterwards as the doctor was so reassuringly upbeat. I said that the consultant obstetrician had said there was a good chance of hysterectomy but the radiographer seemed to think that that was no more likely than with praevia (not that usual at all) but did stress that as I was still risky it could change but certainly wasn't the case now. She wants to see me herself in six weeks time - but that in itself seems reassuring that it isn't sooner. Also, there was no talk of having to spend the last few weeks of pregnancy in hospital which the obstetrician and midwife had mentioned before.

I spoke to my midwife this morning who has organised a lengthy appointment with the consultant obstetrician to talk about it all. I know that praevia can still be a serious complication, but at least it's less usual to have a hysterectomy (or die) so I am feeling much more confident. The midwife did sound more relaxed today and told me to call triage as soon as I have a bleed - a big improvement on previous advice to phone for an ambulance!

Thanks, everyone, for all the supportive posts. I shall post any updates on here. I really appreciate it as this has been a horrible 10 days since I went into hospital for the bleed - I'm completely shattered from all the emotion of it. DH says he wishes we'd never been told about the accreta but I suppose doctors have to tell you what they're worried about or looking for, and I know it's not exactly a perfect pregnancy. But nontheless, I feel a lot more hopeful about the outcome. Oh, and they told me I'm having another boy and that the placenta should be working fine as he looks healthy .

Brilliant news!! What a relief for you. Phew!

Oh thank God for that! Excellent news.

Praevia is more common with boys - isn't that wierd? They like to cause trouble from the start.

Oh that's wonderful news, Speccie. I'm so pleased for you and glad you can relax a bit. You've been so brave through a real scare.

glad to hear this

Great news and I'm really glad that your scan gave you some (much-needed) reassurance. I don't want to freak you out but it's worth considering possibility of a repeat bleed, especially as your placenta is covering your cervix - this does put you at a high risk of bleeding and it's important that if this does happen you hot-foot it to hospital.

I had placenta praevia with my twin pregnancy, which was diagnosed at my twenty week scan. Oh well, thought I, as my consultant outlined the risks....but then I bled from 23 weeks onwards with increasing regularity and severity. The bleeds triggered labour at 23 weeks (dire), 25 weeks and 30 weeks, all of which were blocked with drugs as soon as I got to hospital. I was lucky. From 30 weeks they kept me in hospital until I had an enormous bleed at 35 weeks. My daughters were born well and healthy at 35 weeks.

I don't want to scare you as it sounds as you've been scared enough over the past week. I actually think it's very reassuring that this has been picked up as consultants/midwives will now be ALL over you and your delivery will be very well-attended, which is no bad thing. However, it's good to have an 'emergency mindset' for the bleeds; a plan of action if you like. Until I was kept in hospital I carried my notes with me everywhere (even though they were like a book by the end!) and always had my mobile on and juiced up in case I needed to call an ambulance. I also had what I called my 'bleed bag' at home, which was always packed for a last-minute dash to hospital (a nightdress, some mini toiletries, a book, flip flops, a cardigan, etc. Stuff to get you through a 24 hour stay...). So if I did start to bleed there was minimal faffing around. I'm glad I did as at my 23 week bleed I was already going into labour by the time I got to hospital (20 minutes) and it was a bet as to whether the drugs would block the labour or not. They did, thank God, but it was a bleak few hours on the labour ward whilst we waited to find out.

The fact that you've been diagnosed is really reassuring but please get lots of rest and take things as easy as you can. THere is no guarantee that you will bleed again, but there is evidence to suggest that the easier you take things the less likely it is. THey call it 'pelvic rest' and it's really dull (no sex, no orgasms, no lifting, no exercise, etc.) but it does mean no hoovering, which is a bonus in my view.

Wishing you the best with the rest of your pregnancy. Placenta praevia is really scary but once they know about it you're in very safe hands and get very well looked after. I always felt in very good hands and I got through - womb intact and am even considering another pregnancy!.

Take care.
K

Hi
I was diagnosed with placenta acreta 4 years ago when i had a section to deliver a healthy 10lb baby boy. The surgery went well with no haemorrhage at the time but the surgeon said she had difficulty removing the placenta and some maybe retained.
I kept bleeding afterwards steadily (like heavy ish period )
My health visitor suggested seeing gp and cut a long story short saw consultant who arranged scan and had d&c and then told about placenta acreta.
So that time all went fine and i dont think i appreciated how serious this condition could be.
Now i am 33 weeks pregnant with baby no. 2 and at my last appointment at 28wks was told that as well as section, i would need g/a not spinal and consent to hysterectomy. It was laid on the line about the risk of haemorrhage and had i not been through this already i would also have been very very scared.
Next tuesday i have a scan on the placenta and ?mri to try and see extent of condition this time and then section will be booked for 39 weeks. I will argue the spinal verses g/a argument though.
I know its scary and i've read all the horror stories as well but i can say hand on heart i have been through it with no major trauma and knowing the risks have done it again.

Good luck, i will let you know what consultant says next week.

Emma x

Wow - this thread has been so informative and supportive, I keep saying thanks but really all these posts are so appreciated.

Kitstwins - Labour at 23 weeks, that must have been terrifying! I'm aiming to be 'calm and prepared' for any more bleeds I might have. Not sure about the calm bit but I have got a bag packed for hospital: DH made me, he said it's like taking an umbrella to make sure it doesn't rain. (Here's hoping.) The placenta is touching the cervix, I know this is still serious, but I'm grateful it isn't lying full across it. I think the problem is a bit further up and to the left IYSWIM! It's great to hear you got to 35 weeks despite praevia and twins, and that you're thinking of having another. That's really reassuring.

BabyD - Congratulations and good luck with no. 2. So it can be done! I'd read that many cases of accreta are only diagnosed at the time of the birth or just after, and that the placenta can be successfully retained to keep fertility. (Does this mean they just diagnose accreta again? Is it like once you've had it once you'll definitely have it next time and the placenta grows in the same place?) Loads of good luck for Tuesday, I hope the scan goes well for you. I was worried about the spinal vs. G/A too and I still haven't spoken to the consultant about it - I think I have to wait til a bit later in my pregnancy. I know a highly medicalised birth isn't nec desirable but I also hear what Kitstwins says about how it isn't a bad thing for the birth to be well attended, etc, and I'm over hoping for a VBAC water birth, sadly. Not quite the same thing as being passed out when my child arrives, I know, but I guess I'm telling myself that I'd best just do what the doctors say. If you feel like it, come back and post and let us know how it goes as I'd be really interested to hear.

Boys more associated with praevia, eh? Male causes greater female inconvenience = no surprise .

speccie - great news but am with kitstwins pp is very scary as have already said. glad to see you've got a bag packed.

i had a boy too - I knew he'd be trouble .

I'd make sure you plan for at least a week in hospital (with a bleed related admission rather than delivery) regards DH, your other DC etc. Organise a list of friends to call in an emergency etc - my first bleed, I was in the GP carpark with DD2. GPs saw me but DH was 35miles away, am so glad my friend happened to be 2mins away - was so scared but trying to contain myself for dd2's sake.

Hey, BabyD, hope all ok with your scan today. I've been thinking of you

BabyD - think I had a similar situation to you.....had a retained placenta following the normal delivery of DS2, which ended up in a manula removal under spinal block (not pleasant). The doctor doing the procedure mentioned that he thought it was an accreta, and my independent midwife put this in her notes (though it was not mentioned in my hospital records at all). Following the birth, I had a scan due to heavy bleeding and I still had retained placenta which was removed with a D&C (though not a huge amount), and the consultant said this was consistent with accreta. Now I am umming and aghhing about another pregnancy - the consultant who did the D&C has painted a bleak picture of hysterectomy and possible death, while my midwife tells me loads of people have retained placenta and it causes no issues 2nd time round.......plus if it was such a serious condition, wouldn't the hospital have briefed me following the birth? I really want another baby, but I'm just so confused about the levels of risk involved, and indeed whether or not I really did have placenta accreta in the first place (as during the manual removal at no time did it ever seem to be a "dangerous" or "life threatening situation")

Confused!!!! (and broody)

lumpasmelly - that's really bad of the hospital not to be clearer with you at the time. I haven't managed to find that much out about post-accreta pregnancy but my midwife told me about someone she's seen who'd gone on to have a successful normal pregnancy so it can't be that unheard of. Can your GP refer you back to consultant obstetrician? Good luck with finding out. It must be frustrating not know exactly what's gone on, etc. I hope things are ok.

Hi SpeccieSeccie - I think I'm in a similar situation to you - just had 20 week scan and discovered that I have complete placenta previa - i.e. its covering the whole cervix. I too have had previous c-section and am going for another scan - I think to see if there are any signs of placenta acreta - in about a month.

It's really helpful to know that you've had some postive feedback about it, the stuff on the web is pretty scary. I was hoping for a homebirth - har! As a matter of interest did anyone every mention to you that this is a complication of c-sections? I don't think anyone did to me, but I was a bit too dazed to take everything in!

Anyway hope all is well. I'd love to know if there are any developments and how you get on.

R

I've wondered about that: absolutely no one mentioned this as a possible side effect of my caesarean ... or at least I don't think they did. My DS was breech and sort of lodged quite high up so I was strongly recommended a c-section which I was happy about (and would do again despite this). Maybe I just didn't read through all the negatives or chose to ignore them.

I hope the scan is reassuring, Reki. I told myself that if it was going to be one of the really bad cases then they'd have been able to see it on the earlier scan straight away. Of course, having zero medical experience I'm not sure if that's actually true but it helped me! If you feel like posting afterwards, I'll be interested to hear what they've said.

I'm so glad you said that - I thought that I just hadn't concentrated enough when they were talking me through the potential complications. Another friend of mine was told not to fall pregnant again within a year (after a section) - again I don't remember anyone mentioning that to me. (DD1 will be 19 months when DD2 is born!)

DD1 was breech too - the consultant nearly broke her thumbs trying to dislodge her from my pelvis during the ecv! I'm with you though, I can't imagine making a different decision about the c-section, even given my current situation.

Will definately post again after scan - keeping my fingers crossed.