Placenta Accreta

Placenta accreta is one of the most serious complications a mother can face during pregnancy and delivery. When the placenta attaches too deeply into the uterine wall, it cannot separate naturally after birth, leading to severe bleeding that can become life-threatening within minutes. For families who receive this diagnosis, understanding what placenta accreta means, how it will be managed, and what to expect can bring clarity during an uncertain and frightening time.

This condition requires specialized medical care, careful planning, and often a large team of experts working together. While the diagnosis is serious, early detection and coordinated treatment at experienced centers have significantly improved outcomes for mothers and babies. This page explains what placenta accreta is, why it happens, how it is treated, and what families should know as they navigate this high-risk situation.

What Is Placenta Accreta and Why Does It Happen?

Placenta accreta occurs when the placenta grows too deeply into the muscular wall of the uterus, rather than remaining in the superficial lining where it can detach easily after delivery. This abnormal attachment happens because the normal barrier between the placenta and the uterine muscle is damaged or absent, often due to scarring from previous surgeries.

The term “placenta accreta” is actually part of a larger group of conditions known as the placenta accreta spectrum, or PAS. The spectrum reflects how deeply the placenta has invaded:

Placenta accreta is the most common form, where the placenta attaches to the surface of the uterine muscle but does not invade deeply.

Placenta increta involves deeper invasion into the muscular layer itself.

Placenta percreta is the most severe form, where the placenta grows completely through the uterine wall and may attach to nearby organs such as the bladder or bowel.

All forms of the condition prevent the placenta from separating on its own after birth, which normally triggers the uterus to contract and stop bleeding. Without that separation, hemorrhage can be rapid and uncontrollable.

What Causes Placenta Accreta?

The most significant cause of placenta accreta is uterine scarring from prior cesarean deliveries. Each cesarean section leaves scar tissue on the uterus, and when a future pregnancy implants over or near that scar, the placenta may grow into it rather than staying in healthy tissue. The risk increases with each additional cesarean delivery.

Other factors that raise the likelihood of placenta accreta include:

• Placenta previa, a condition where the placenta covers the cervix, especially when combined with a history of uterine surgery
• Previous uterine surgeries such as myomectomy (fibroid removal) or dilation and curettage (D&C)
• Multiple prior pregnancies
• Advanced maternal age
• Prior uterine infections or inflammation that may have damaged the lining

The incidence of placenta accreta has risen dramatically over the past several decades. What was once a rare complication is now seen in approximately 1 in 533 to 1 in 2,500 births in the United States. This tenfold increase over the last 50 years is directly linked to rising cesarean delivery rates.

How Placenta Accreta Is Detected?

In most cases, placenta accreta causes no symptoms during pregnancy. Some women may experience vaginal bleeding in the third trimester, but this is not always present and is not specific to accreta.

The majority of cases are identified through routine prenatal imaging. Ultrasound is the primary screening tool, and findings such as abnormal blood vessel patterns, thinning of the uterine wall, or loss of the normal boundary between the placenta and uterus can raise suspicion. When ultrasound suggests accreta, MRI may be used to better define the extent of invasion and help plan surgery.

Because early detection is critical to managing the condition safely, women with known risk factors such as placenta previa and a history of cesarean delivery should be closely monitored with targeted imaging.

Preventing Placenta Accreta

There is no way to completely prevent placenta accreta, but the risk can be reduced by limiting unnecessary uterine surgeries, particularly cesarean deliveries. Each cesarean increases the likelihood of placenta accreta in future pregnancies, which is why shared decision-making around delivery planning is so important.

For women who are at high risk due to prior surgeries or placenta previa, early and ongoing screening allows for timely diagnosis and referral to specialized care centers. Education about the risks associated with repeat cesarean deliveries helps families make informed choices and prepares them for the level of care that may be needed.

Medical Care and Treatment

Placenta accreta is considered a true obstetric emergency when not anticipated, and even with planning, it requires an exceptional level of coordination and expertise. Treatment almost always involves delivery by cesarean section followed by hysterectomy, the surgical removal of the uterus. This is done to control bleeding and prevent life-threatening hemorrhage.

Planned Delivery at a Specialized Center

Because of the complexity and risk, delivery should be scheduled at a major medical center with experience managing placenta accreta spectrum disorders. These centers have access to:

• Maternal-fetal medicine specialists
• Experienced obstetric surgeons
• Anesthesiologists trained in high-risk obstetrics
• Interventional radiologists who may assist with controlling blood flow
• Neonatologists for newborn care
• Blood bank services capable of rapid, large-volume transfusion
• Intensive care units for postoperative maternal support

Hospitals such as NYU Langone, Columbia University Irving Medical Center, and Montefiore Einstein in New York run dedicated placenta accreta programs where multidisciplinary teams work together to create individualized care plans.

Timing of Delivery

Delivery is typically planned between 34 and 36 weeks of pregnancy. This timing balances the risk of preterm birth to the baby with the risk of uncontrolled bleeding if labor begins spontaneously. Corticosteroids are usually given before delivery to help the baby’s lungs mature.

Hysterectomy and Alternatives

In the vast majority of cases, a hysterectomy is necessary to stop bleeding and save the mother’s life. Hysterectomy rates approach 90% for placenta accreta and nearly 100% for the more invasive forms, increta and percreta.

Some medical centers offer conservative management in select cases, where doctors attempt to leave the placenta in place or remove it without performing a hysterectomy. This approach is only considered when the mother strongly desires to preserve fertility, the invasion appears limited, and the risks are thoroughly understood. Conservative management carries a significant risk of infection, delayed hemorrhage, and the eventual need for hysterectomy anyway. It requires close monitoring and should only be done by teams with specific expertise.

Blood Loss and Transfusion

Massive hemorrhage is the primary danger in placenta accreta. Blood loss during delivery can exceed several liters, and transfusion of red blood cells, plasma, and platelets is common. In severe cases, women may require care in the intensive care unit after delivery.

Advances in surgical technique, blood product management, and anesthesia have greatly improved survival, but the condition still carries a substantially higher risk of maternal morbidity and mortality compared to normal deliveries.

Outcomes and Long-Term Considerations

With early diagnosis and planned delivery at an experienced center, outcomes for mothers with placenta accreta have improved significantly. Maternal death is rare when the condition is anticipated and managed appropriately, though it remains much higher than in uncomplicated births.

Most women recover physically over several weeks to months following hysterectomy. Emotional recovery can take longer. Losing the ability to carry future pregnancies is a profound experience, and many women benefit from counseling, peer support, or connection with others who have been through similar experiences.

Babies born to mothers with placenta accreta are typically healthy, though they are often delivered preterm and may require a short stay in the neonatal intensive care unit depending on their gestational age at birth.

Support and Resources for Families

Receiving a diagnosis of placenta accreta can feel overwhelming. Families suddenly face complex medical language, difficult decisions, and the reality of a high-risk delivery. It is normal to feel scared, confused, or grieve the loss of the birth experience you had hoped for.

Support begins with clear communication from your medical team. You should feel comfortable asking questions, understanding each step of the plan, and knowing what will happen on the day of delivery. If your current provider does not have experience managing placenta accreta, ask for a referral to a center that does.

You may also benefit from:

• Meeting with a social worker or counselor who specializes in high-risk pregnancies
• Connecting with support groups for women who have experienced placenta accreta
• Learning about postpartum resources, especially if a hysterectomy is planned
• Planning for practical needs such as childcare, transportation, and time off work during recovery

At NYBirthInjury.com, we provide trusted, evidence-based information to help families understand serious pregnancy and birth complications. We also connect families with qualified medical professionals and support resources across New York and beyond.

Moving Forward After a Placenta Accreta Diagnosis

Placenta accreta is a serious, life-altering diagnosis, but it is also one that can be managed with expert care, advanced planning, and the right team. Early detection, delivery at a specialized center, and access to comprehensive support make all the difference in outcomes.

If you or someone you love has been diagnosed with placenta accreta, know that you are not alone. There are experienced professionals ready to guide you, evidence-based treatments that work, and a community of families who understand what you are facing. With the right information and support, you can move forward with confidence, even in the most challenging circumstances.