GUIDE
Placenta accreta is a serious condition where the placenta grows too deeply into the uterine wall and does not detach normally after delivery — potentially causing life-threatening hemorrhage.
Placenta accreta spectrum disorders have become more common as cesarean delivery rates have risen. With early diagnosis and careful planning at a specialized center, outcomes for both mother and baby are significantly improved.
Be prepared from day one
In a normal pregnancy, the placenta attaches to the uterine lining (endometrium) and separates cleanly after the baby is delivered. In placenta accreta spectrum disorders, the placenta attaches too deeply — growing into, through, or beyond the muscular wall of the uterus. This abnormal attachment means the placenta cannot be delivered normally, and attempting to remove it can cause severe, life-threatening bleeding.
Placenta accreta has become more common, now affecting an estimated 1 in 500 pregnancies — up from 1 in 2,500 in the 1980s. This increase closely tracks the rise in cesarean delivery rates, as prior uterine scarring is the primary risk factor. Understanding what happens during a C-section can help you understand how scarring develops.
The combination of placenta previa and a prior cesarean delivery carries the highest risk. When the placenta implants over a cesarean scar and grows into the scarred area where the endometrium is thin, accreta is much more likely to develop.
The depth of placental invasion determines the severity. Most cases are accreta (the least severe), but increta and percreta require more complex surgical management.
The combination of placenta previa and prior cesarean delivery is the highest-risk scenario. With placenta previa and one prior C-section, the accreta risk is about 3%. With three prior C-sections, it rises to 40% or more.
Placenta accreta is most often detected during a routine ultrasound, particularly when the provider is specifically looking for it in high-risk patients. Ultrasound signs include loss of the normal clear zone between the placenta and the uterine wall, irregular blood vessels extending from the placenta into the myometrium, and thinning of the uterine wall behind the placenta.
MRI can provide additional detail, especially for suspected percreta where the placenta may be invading the bladder or other structures. However, ultrasound in experienced hands remains the primary diagnostic tool.
In some cases, placenta accreta is not diagnosed until delivery — when the obstetrician attempts to deliver the placenta after the baby is born and it does not separate. This is why risk factor awareness is crucial: if you have placenta previa plus prior cesarean deliveries, your provider should be specifically evaluating for accreta on ultrasound.
Delivery of a pregnancy complicated by placenta accreta requires meticulous planning. ACOG recommends that suspected accreta cases be delivered at a center with multidisciplinary expertise — including maternal-fetal medicine, gynecologic oncology or experienced pelvic surgeons, anesthesiology, a well-stocked blood bank, and a NICU.
Delivery is typically planned at 34 to 36 weeks — balancing the baby's maturity against the risk of an unplanned bleeding episode that could lead to emergency surgery under less controlled conditions. A course of corticosteroids is given before 34 weeks to accelerate fetal lung development.
The standard approach for confirmed accreta is a cesarean hysterectomy — delivering the baby through a cesarean incision and then removing the uterus with the placenta still attached, without attempting to separate the placenta. Attempting to peel the placenta away from the uterine wall can cause massive hemorrhage. Average blood loss during cesarean hysterectomy for accreta is 2 to 5 liters — which is why having blood products readily available is essential.
If you are being managed as a high-risk pregnancy, your maternal-fetal medicine specialist will coordinate the surgical team and delivery plan well in advance.
If placenta accreta is suspected, ACOG recommends delivery at a center of excellence with a multidisciplinary team — including maternal-fetal medicine specialists, experienced surgeons, anesthesiologists, a blood bank with adequate supplies, and a neonatal intensive care unit. Outcomes are significantly better at high-volume centers with experience managing accreta. Ask your provider about referral if needed.
A placenta accreta diagnosis brings uncertainty. You may face the possibility of hysterectomy, significant blood loss, ICU stay, and a longer recovery. Allow yourself to process these possibilities with your partner, family, and a mental health professional if needed. Being informed and emotionally prepared — while hoping for the best outcome — can help you feel more in control.
Because accreta carries a high risk of hemorrhage, your care team will prepare by having multiple units of blood products available. Some providers recommend autologous blood donation (banking your own blood before delivery) in the weeks before your scheduled surgery. Discuss this option and timing with your provider.
Recovery from a cesarean hysterectomy takes longer than a standard C-section — typically 6 to 8 weeks or more. Arrange for help at home with the baby and older children. You will not be able to drive, lift anything heavy, or do strenuous activity during recovery. If you have a NICU stay for the baby, factor in travel and time at the hospital.
Any vaginal bleeding or contractions before your scheduled delivery date should be treated as an emergency. Go to your designated hospital immediately.
Recovery after cesarean hysterectomy is longer and more complex than a standard cesarean. You may spend time in the ICU for monitoring, and total hospital stay is typically 4 to 7 days if there are no complications. Blood transfusion is common, and you will be monitored for signs of infection, blood clots, and organ function.
A hysterectomy means you will not be able to carry future pregnancies. This reality adds an emotional dimension to the medical experience. Many people grieve the loss of fertility even while feeling grateful for a safe outcome. Professional support — from therapists, social workers, and support groups — can be invaluable during recovery.
For related information, see our guides on placenta previa, high-risk pregnancy, bleeding during pregnancy, and preeclampsia.
This guide is for informational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider with any questions about your pregnancy.
