Re: Placenta growing into uterine wall

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I had the same thing happen to me when I delivered my baby last Sept. I required an emergency D&C and hemorrhaged 4 liters of blood (needing a transfusion). I believe when the placenta adheres tightly to the uterine wall its placenta accreta, when it grows into the uterine wall it's placenta increta. THis can worsen to a condition called placenta percreta, where the placenta grows THROUGH the uterine wall. With my situation, she was my 3rd child (4th pregnancy...all being vaginal deliveries) and my second child, they believe was a case of placenta accreta. Also, the placenta had implanted on the anterior side. And I had had a D&C between the second and third child (miscarriage). Finally, I was told that IF I did have another pregnancy, and it did progress to percreta, it would mean a c-section with the removal of the uterus at that time.

Here are some of the questions I asked and the responses I received...

>Does placenta percretia ALWAYS follow placenta incretia?

There are 3 types of abnoraml "stickiness" of the placenta to the uterine wall -- accreta (unusually firm adherence); increta (the placenta penetrates into the uterine wall to some degree); and percreta (the placenta goes all the way thru the uterine wall and may even invade the bladder). Percreta, obviously the worst type, does not necessarily always follow increta; in fact, a percreta can happen without ever having an accreta or an increata before. Also, just because one had an accreta or increta before does not mean one will go to the next step with a subsequent pregnancy.

>Does it depend on where the embryo implants?

The chance of developing any of these is higher if there is also a placenta previa, which arises when the embryo implants very low. Other risks include scarred uterus (c-section, myomectomy that entered the uterine cavity, D&C) and multiple (>5) prior pregnancies.

>If the embryo did NOT implant on the anterior side, would my chances of this happening be the same?
You are in a high risk category due to prior D&Cs as well as a prior accreta or increta -- your uterus is scarred, and although this scarring may be worse where the placenta was previously implanted, a D&C "hits" the entire uterine cavity.

>Is there any way to determine before another pregnancy if there is something on the anterior side that is making this more likely (as possibly a c-section incision, which I DO NOT have), like a cyst or something? Would a cyst make this more likely?
No way that I know of of telling for sure pre-pregnancy, although a hysteroscopy may help in seeing if the uterine lining looks particularily bad in any area. Cysts would not be a factor. The problem is, even if we knew what area was "bad", we can't do a darn thing about where implantation occurs.

>IF I did get pregnant again, and it did implant on the anterior side, is it a foregone conclusion that the placenta would again imbed itself in my uterus?
No, although the chance is higher than wiht someone without your history.

>How likely is an US going to be at picking this up,

especially if it is known to look for it? Ultrasound -- with an experienced sonographer-- can be very good in detecting placenta increta or percreta.The normal sonolucent area beneath the placenta is lost with an increta or percreta. It requires careful scanning.

>Finally, IF I did end up having my uterus removed, aside from not having periods, what would the effect of this be on my body?(I'm assuming my OB would leave the rest of my reproductive organs intact as I have never had a problem with any them...no cysts, no bad paps...nothing)
A hysterectomy without removal of the ovaries, like any other surgery can have complications (risk of anesthesia, bleeding, infection). Other than lack of periods (and inability to be pregnant!), one thing unique to hysterectomy MAY be a change in orgasms -- some women who find uterine crampiness to be a pleasurable part of orgasm will no longer experience this particular sensation. Many women like sex better because they don't have to worry about pregnancy and whatever led to the hyster may have interfered with their sex lives.

Hope this helps. From my own experience, my Dr was SO on top of my condition the second time around because I continuously brought to his attention throughout my pregnancy that I had a deteriorated retained placenta with my second child. It would be good if your daughter brought this to the attention of her OB and if she is having an US, to the sonographer, to see if they can see if this will be a repeat of the previous pregnancy.

Good Luck.

--
Carolyn

At Thu, 18 Mar 1999, Linda wrote:
>
>My daughter gave birth last October and ran into complications.  Although
>the birth was normal, she did not expel the placenta properly, so the
>doctor assisted her and "pulled" on the placenta.  My daughter very
>suddenly ended up hemorrhaging, requiring 2 units of blood, and the
>doctor told her that the placenta had "grown into the uterine wall".  In
>searching the "OBGYN" web site, I found one article that mentions
>something similar called "placenta accreta".  Is this the term for what
>happened to my daughter? She is approximately 11 weeks pregnant again,
>and was advised that this could happen again, yet her GP does not
>consider this a "high risk" pregnancy.  We are obviously concerned, and
>I have suggested she seek a second opinion of a specialist, but we would
>like to research this a bit first.  At what stage of pregnancy does this
>type of thing occur, and what would cause it? Can an ultrasound or MRI
>detect this? Is a C-section normally warranted? Prior to becoming
>pregnant the last time, she had miscarried and the doctor did a D & C --
>did this have anything to do with the placenta abnormality? When she
>hemorrhaged, they immediately rushed her into a surgery room and did yet
>another D & C, and now has become pregnant too quickly again, so is
>worried that this may have some bearing on this.
>
>Any information you can provide would be appreciated.  We live in BC,
>Canada, and have found that we receive better medical care when we
>research ourselves and advise the doctor exactly what we want whenever
>possible.
>
>Thanks for your assistance.
>
>--
>Linda
>

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