Placenta accreta spectrum (PAS) is a condition when the placenta attaches and invades deeply into the uterine wall during pregnancy, according to the National Accreta Foundation. There can be different degrees of invasion:
- Placenta accreta, which is when the placenta is attached to the uterine wall only (about 50% of PAS)
- Placenta increta, which is when the placenta is invades more than 50% of the uterus (about 15% of cases of PAS)
- Placenta percreta, which is when the placenta goes through the uterine wall and possibly into other organs, such as the bladder or bowel (about 5% of cases of PAS)
One in 272 pregnancies involves PAS. However, the condition has been rising in the U.S.
What Are the Risk Factors?
If you have had multiple cesarean sections (C-sections) or multiple uterine surgeries, you are at higher risk of experiencing PAS in a pregnancy. Even those with just one prior cesarean section may be at increased risk. Additional risk factors include:
- Undergoing dilation & curettage (D&C), which is a procedure where tissue is scraped or removed from the uterus
- Having given birth to two or more children
- Being 35 years old or older during a pregnancy
- Having placenta previa, which is when the placenta is implanted low in the uterus and partially or completely covers the cervix
- Having conceived through in vitro fertilization (IVF)
What Are the Possible Complications For my Pregnancy?
PAS can be serious, leading to other pregnancy and health complications. The main possible complications can include:
- Additional surgical procedures, including a hysterectomy at the time of cesarean section
- Extreme blood loss requiring blood transfusion
- Long hospital stay
- Damage to organs surrounding the uterus, such as the bowel or bladder
- Loss of fertility
- Kidney failure
- Respiratory failure
- Death
Can PAS Harm My Baby?
In most cases, PAS does not harm the baby. However, PAS can result in early birth, which carries a risk of complications. These pregnancies are most often delivered between 34-36 weeks of gestation.
Common complications the baby may experience due to preterm birth include difficulty gaining weight or trouble breathing. It is possible that the baby could have a brief stay in a neonatal intensive care unit before coming home.
What Are the Symptoms of PAS?
PAS usually presents with no symptoms. However, some women report pelvic pain due to the placenta putting pressure on the bladder or other organs. Some women also experience bleeding during pregnancy, especially if placenta previa is present.
How Am I Diagnosed with PAS?
In most cases, PAS is diagnosed through an ultrasound during pregnancy. If needed, your medical provider may order an MRI to see how deep the placenta is in your uterine wall. The earlier PAS can be diagnosed, the lower the likelihood of complications.
At times, it is unknown if a mother has PAS until after the baby is born. PAS can be suspected if the placenta does not come out within 30 minutes of the birth.
Is PAS Treatable?
Treatment of PAS may involve an early C-section delivery between weeks 34 and 37 of pregnancy. If the placenta does not deliver, a hysterectomy is performed at the same time.
Can I Prevent PAS?
Unfortunately, PAS cannot be prevented. However, if you are at risk of developing PAS, you can receive prenatal care at a facility that has expertise in diagnosing and treating PAS. This can help you avoid negative complications associated with PAS or from other pregnancy-related conditions.
UofL Physicians – Maternal-Fetal Medicine, part of UofL Physicians – OB/GYN & Women’s Health, is here to support you and your baby before, during and after pregnancy. Call 502-588-4400 to schedule an appointment.
UofL Health – UofL Hospital – Center for Women & Infants offers services to meet your needs for low-risk and high-risk pregnancies during and after the pregnancies. We offer the most advanced and innovative maternity care available, and we are the only team in Kentucky that has expertise in treating PAS. Contact the Center for Women & Infants by calling 502-562-3325.
