Women who have placenta previa are considered to be at high risk for placenta accreta and should deliver their babies by cesarean section whenever possible. In the event of severe bleeding, the health care providers will be prepared to perform blood transfusions and/or a hysterectomy (removal of the uterus)-if necessary.
If placenta accreta is diagnosed during pregnancy, normally delivery occurs at 36 weeks by cesarean hysterectomy (delivery of the baby and removal of the uterus). Delivery is planned at a tertiary care hospital with facilities to manage complications in both the mother and baby from severe bleeding. In many cases prior to delivery, mothers undergo a procedure called balloon catheterization. This procedure involves placing deflatable balloons in the large maternal blood vessels that supply the uterus. During the time of surgery, these balloons can be inflated to decrease blood loss. These balloons are normally removed after surgery once bleeding is controlled. In the majority of cases, hysterectomy is the most effective way to control the potentially fatal consequences of placenta accreta.
Unfortunately, some cases of placenta accreta are diagnosed at the time of delivery when the mother experiences continued vaginal bleeding, or heavy vaginal bleeding when an attempt is made to remove the placenta or only part of the placenta is able to be removed. If the mother is unstable due to severe bleeding, emergency surgery is required. Common surgical techniques involve tying off the blood vessels that supply the uterus. On some occasions, if the site where the placenta is attached is small, this part of the uterus can be cut out and sewn up. However, more often than not, a hysterectomy is required.
Studies of 31 recent cases of placenta accreta managed without hysterectomy did not report infertility or maternal death.
These methods should be considered only in patients who are stable and who understand and accept the risks of delayed bleeding, blood clotting disorders, infection, and, possibly, emergency surgery. Though case reports find these maneuvers successful, they are still experimental. Currently, the definitive treatment for placenta accreta, despite time of diagnosis, remains hysterectomy.
