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Diagnosing a dangerous pregnancy complication

February 08, 2018 | UCI Health
pregnant woman having ultrasound

Throughout the nine months of pregnancy, while a baby grows big and healthy inside the mother, a potentially dangerous complication can develop without any outward signs or symptoms. 

Unless diagnosed earlier by an experienced doctor, this complication — placenta accreta — won’t make itself known until the baby is delivered. Then it can deal a crushing blow, potentially causing the mother to lose a life-threatening amount of blood.

It’s a complication that seems like it should be relegated to history in the face of modern medicine. But in fact, the United States has the highest maternal death rate of any developed nation, and hemorrhage from placenta accreta is one of the leading causes of those deaths.

What is placenta accreta?

Placenta accreta is the abnormal growth of the placenta, the structure that develops inside the mother’s uterus to provide oxygen and nutrients to the growing baby.

In a normal pregnancy, the placenta attaches to the uterine lining and it comes out along with the baby during delivery.

However, in some cases, the placenta embeds itself even deeper, attaching to muscles of the uterus or even pushing outside the uterus and attaching to other organs in the abdominal cavity. When this abnormal placenta detaches, it causes excessive — potentially uncontrollable —  bleeding.

Uterine scar tissue is one cause

Placenta accreta was actually quite rare 50 years ago, yet today it occurs in about one in 500 births — in part because of the huge rise in U.S. deliveries by cesarean section over the past 30 years.

“If there’s scar tissue in the uterus, say from a previous C-section, it can give the placenta something to attach onto,” explains Dr. Carol Major, director of the Division of Maternal and Fetal Medicine, a team of UCI Health OB-GYNs specialized in caring for high-risk pregnancies.

“We recommend that any woman with a previous C-section come to us so we can scan for accreta. And if we see the placenta is over the scar, we watch them like a hawk.”

It also can develop in women who have never had a C-section or other uterine surgeries, and who are having seemingly uncomplicated pregnancies.

Detecting accreta is a challenge

Unfortunately, placenta accreta is not always diagnosed in community hospital settings, where it’s not usually looked for and can be hard to detect or predict. Most pregnant women undergo ultrasounds, but placenta accreta may be overlooked unless the sonography images are read by a specialist experienced in detecting its tell-tale signs.

Perinatologists — OB-GYNs who specialize in high-risk pregnancies, such as the UCI Health maternal-fetal specialists — are experts not only at diagnosing placenta accreta but also at safely delivering babies for women who have it because they have the tools and resources immediately available to treat hemorrhaging.

Unlike the standard labor and delivery wing of a community hospital, UC Irvine Medical Center is a tertiary care center, a hospital with highly trained specialists and special services, including a large blood bank on site to quickly provide blood transfusions, which the vast majority of women with placenta accreta will need.

The medical center also has 24/7 surgical backup, interventional radiology and a team of perinatologists with years of experience treating this condition.

Improving maternal safety

In addition to providing a safe place for women with placenta accreta to deliver, the UCI Health maternal-fetal program has also worked to significantly improve mothers’ safety throughout the state of California.

The maternal death rate in California is far better than the overall U.S. rate, thanks to an initiative called the California Maternal Quality Care Collaborative (CMQCC), in which UCI Health perinatologists have taken a leading role.

Through their work with CMQCC, UCI Health experts have helped create protocols for detecting and treating hemorrhage that community hospitals can adopt for their labor and delivery wards.

“By teaching community hospitals standardized steps for how to stabilize patients or transfer them to a center like ours, we’ve been incredibly successful in decreasing morbidity and mortality,” Major says. “As a result of this and other efforts, maternal mortality in California has dropped by 50 percent.”

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