Hearing placenta accreta during a scan or OPD visit can make everything feel urgent. Will there be heavy bleeding? Will the baby need NICU? Will the doctor talk about hysterectomy? These worries are common—and valid. The reassuring part is that placenta accreta is a condition where planning makes a huge difference: timely imaging, the right specialists, blood availability, and a delivery plan that avoids last-minute emergencies.
Understanding placenta accreta and what it means for birth
What placenta accreta is in simple words
Placenta accreta (often grouped under “placenta accreta spectrum”, PAS) means the placenta has attached too deeply to the uterus (womb). In most deliveries, after the baby is born the placenta separates from the uterine lining, and the uterus contracts to control bleeding. With placenta accreta, the placenta does not separate in the usual way, so the risk of postpartum haemorrhage (heavy bleeding after birth) is higher.
One point needs to be said clearly: placenta accreta is not caused by something you did or did not do. It is a medical attachment problem, usually linked to scarring inside the uterus.
Accreta, increta, percreta: the spectrum
Doctors describe PAS by how far placental tissue extends:
- Placenta accreta: firmly attached to the uterine wall, closely contacting the uterine muscle.
- Placenta increta: grows into the uterine muscle (the myometrium).
- Placenta percreta: grows through the uterine wall and may involve nearby organs, most commonly the bladder.
Placenta accreta vs placenta previa
- Placenta previa: placenta is low and may cover the cervix (location issue).
- Placenta accreta: depth-of-attachment issue.
They can occur together, and that combination increases bleeding risk.
How common placenta accreta is and why rates are rising
Placenta accreta is uncommon, but it is being diagnosed more often. A key reason is the rise in cesarean deliveries: scars can disturb the normal lining where the placenta implants. Risk increases with each additional prior C-section, and is higher again when placenta previa overlies a scar.
In India, where C-section rates can be higher in some cities and private settings, doctors usually take a detailed history of past uterine surgeries and advise delivery in a centre with strong blood-bank support.
What happens in the body with placenta accreta
The “missing separation layer” problem
Early in pregnancy, the placenta attaches to the uterine lining. The decidua acts like a controlled interface so that after birth the placenta can separate and the uterus can clamp blood vessels.
In placenta accreta, the decidua at the implantation site may be thin or absent (often around scar tissue in the lower uterine segment). Placental villi can then attach directly to muscle, or extend into it. That is why pulling on the placenta can trigger severe bleeding.
You may see terms like decidua basalis or the Nitabuch layer in reports—both relate to the normal boundary that limits placental invasion.
Severity and location: why your doctor keeps asking “where is the placenta?”
Depth (accreta/increta/percreta) matters, but so does location:
- Anterior placenta may lie close to the bladder.
- Lower-segment involvement often overlaps with placenta previa and scar tissue.
- Suspected percreta may need urology support to protect the bladder and ureters.
Placenta accreta risk factors
Doctors become more alert for placenta accreta when there is:
- prior C-section (risk rises with number of C-sections)
- placenta previa with prior C-section
- previous uterine procedures: D&C, myomectomy, operative hysteroscopy, endometrial ablation
- Asherman syndrome (intrauterine adhesions)
- maternal age over 35, multiparity
- IVF/ART pregnancy (association reported)
Signs and warning situations
Many pregnancies with placenta accreta feel normal. Bleeding is more common when placenta previa is present.
Call your maternity team urgently for:
- any third-trimester vaginal bleeding (even spotting)
- heavy bleeding, dizziness, fainting, unusual paleness
- severe or persistent lower abdominal/pelvic pain
- regular contractions before the planned date
- clearly reduced fetal movements
If bleeding is heavy or you feel faint, go to emergency.
Diagnosing placenta accreta during pregnancy
Ultrasound with Doppler is first-line
Ultrasound (transabdominal plus transvaginal) with Doppler is the main test. Signs can include placental lacunae, loss of the “clear zone”, myometrial thinning, placental bulge, and bridging vessels on Doppler.
MRI: selected use
MRI may be suggested when ultrasound is unclear (for example, posterior placenta) or when deeper invasion/organ involvement needs clarification.
Follow-up scans
With strong risk factors, reassessment is often done around 18–20 weeks, 28–30 weeks, and 32–34 weeks, then adjusted based on stability.
Possible complications of placenta accreta
For the mother, the main issues are major haemorrhage, transfusion, shock, and clotting problems such as DIC. With percreta, the risk of bladder/ureter injury rises, and ICU/HDU monitoring may be needed.
For the baby, the common challenge is planned early delivery, increasing the chance of prematurity and NICU admission.
Emotional recovery also matters. After a high-risk birth or fertility-changing surgery, anxiety or low mood can appear later, mention it during follow-up.
Getting care after placenta accreta is suspected
Best outcomes usually come with a coordinated team and a hospital that can handle heavy bleeding: senior obstetric surgeons, anaesthesia, blood bank, ICU/HDU, neonatology/NICU, and sometimes interventional radiology or urology.
Planning often includes:
- blood group and crossmatch, and a massive transfusion protocol readiness
- correcting anaemia (oral or IV iron) when time allows
- practical planning for appointments, travel, and longer hospital stay
Planning delivery with placenta accreta
Many protocols plan delivery around 34–35+6 weeks for higher-risk PAS, balancing maternal safety and fetal maturity. Antenatal steroids may be offered if preterm delivery is expected.
A planned C-section is commonly advised, often avoiding labour to reduce bleeding triggers.
Standard surgical approach: cesarean hysterectomy
In many cases of placenta accreta, the safest definitive treatment is a planned cesarean hysterectomy (baby delivered by C-section, then uterus removed in the same operation).
Often, the placenta is left in situ because trying to peel it away can cause catastrophic bleeding.
Conservative (uterus-sparing) options: only in selected cases
Some stable cases may be offered uterus-sparing approaches, such as leaving the placenta in situ to shrink over time, or focal resection with uterine repair. These options need strict follow-up and accept higher risks (delayed bleeding, infection, repeat procedures, delayed hysterectomy).
Methotrexate is not routinely used in many centres due to limited benefit and possible toxicity.
Postpartum care and recovery
After PAS surgery, monitoring may be in ICU/HDU for 24–48 hours, with checks of bleeding, urine output, and labs (haemoglobin and clotting profile). Pain control is usually multimodal, and early assisted mobilisation helps recovery.
If bladder repair was needed, catheter care may be longer. If baby is in NICU, lactation support can help with pumping and feeding plans.
Future pregnancies
If the uterus is preserved, a future pregnancy is possible but high risk. Recurrence after conservative management has been reported around 15–30%, so early specialist ultrasound in the next pregnancy is typically planned.
Key takeaways
- Placenta accreta is abnormal deep attachment of the placenta and can cause heavy bleeding at delivery.
- Prior C-section, especially with placenta previa, is the biggest risk factor.
- Ultrasound with Doppler is first-line, MRI may help in selected cases.
- Planned delivery in a tertiary centre with blood readiness and a coordinated team improves safety.
- Common definitive treatment is planned cesarean hysterectomy, often leaving the placenta in situ.
- Selected conservative options exist but need strict follow-up.
- Support exists for medical recovery, feeding, and emotional wellbeing. Parents can download the Heloa app for personalised guidance and free child health questionnaires.
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