During pregnancy the placenta is like the baby’s life support sack. If everything goes according to plan the placenta is supposed to lightly attach itself to the inside wall of the uterus above the baby. When the baby is born the placenta is supposed to detach and come out right afterwards. Placenta accreta is a complication during pregnancy where the placenta attaches itself too deeply into the wall of the uterus and cannot easily detach after birth.
Placenta accreta occurs in 3 degrees of severity based on how deep the placenta digs into the uterus wall. Based on the degree the condition is classified as either placenta accreta, increta, or percreta, but the term “placenta accreta” is generally used to refer to all 3 degrees.
Accreta, Increta, and Percreta
Placenta accreta is known to occur in variable degrees of severity based on how deep the abnormal placental attachment penetrates into the uterus wall. These degrees are formally distinguished as: accreta (1st degree); increta (2nd degree); and percreta (3rd degree).
- Placenta Accreta: a first degree abnormal placenta attachment is classified as placenta accreta. This occurs when the placenta affixes itself deeper than normal into the uterine wall but there is no penetration into the uterine muscles. This mild form of accreta is the most common type and accounts for 3 out of every 4 cases of placenta accreta.
- Placenta Increta: when the placenta penetrates deeper into the wall of the uterus and muscles but does not actually pierce through it is classified as second degree and called placenta increta. Approximately 15% of cases fall into this classification.
- Placenta Percreta: the third and most serious degree of abnormal placental attachment occurs when the placenta pierces completely through the uterine muscles and wall and sometimes even affixes itself to nearby organs. This type of placenta accreta is the least common and only accounts for 5% of all cases.
Placenta Accreta Causes
There are several known risk factors that are known to cause or contribute to placenta accreta, including:
- Previous uterine surgeries: A history of cesarean sections, uterine fibroid removal, or other surgeries on the uterus increases the risk. Scar tissue from these procedures can cause the placenta to embed too deeply.
- Placenta previa: This condition is linked to placenta accreta. The risk increases if placenta previa occurs with a history of uterine surgeries.
- Multiple pregnancies: Women who have had multiple pregnancies (twins) are more likely to develop placenta accreta, especially if they have a history of complications like placenta previa.
- Advanced maternal age: Women over the age of 35 are at higher risk for placenta accreta.
- Abnormalities in the uterine lining: Conditions which cause scarring or thinning of the uterine lining, can contribute to placenta accreta.
Where is the Placenta Supposed to Be?
The placenta is normally attached to the upper part of the uterus, specifically along the back or front wall. It should be positioned away from the cervix, which is the opening of the uterus that leads to the birth canal. This location allows the placenta to provide nutrients and oxygen to the growing baby while ensuring a safe and natural delivery process.
Standard of Care for Placenta Accreta
The precise cause of placenta accreta is completely unknown and the condition occurs somewhat randomly in a small percentage of pregnancies. There are at least 3 conditions which are known to make placenta accreta more likely to occur. Placenta accreta is more likely to occur along with another placental abnormality called placenta previa. Advanced maternal age and a prior history of C-sections are also factors which appear to increase the risk of placenta accreta.
Even with these known risk factors doctors have no effective way of predicting or diagnosing placenta accreta in advance. Placenta accreta is usually discovered only after the baby is delivered and the placenta does not detach and come out normally. In some cases the placenta will tear off and come out after delivery and accreta is diagnosed based on the resulting hemorrhaging. This is because when the uterus cannot contract, the blood vessels cannot contract, and the result is excessive bleeding. In other cases the placenta may not fully detach from the uterus at all and require surgical intervention.
Placenta accreta can potentially be harmful to babies, mainly because it can trigger premature delivery. However, placenta accreta is more of a health risk for mothers than for babies. Placenta accreta can cause significant damage to the uterus. When the placenta attaches too deeply or penetrates through the uterus wall it either tears off or has to be surgically detached after the baby is born. Either of these situations create a real danger for the mother because when the placenta tears off it causes major damage to the uterus. More serve cases (placenta percreta) will basically leave the mother with a jagged tear or gaping hole thru her uterus.
This type of extensive tissue damage to the uterus is not something which doctors can simply stitch back together. When placenta accreta causes irreparable injury to the uterine tissue the standard of care calls for immediate surgical removal of the uterus. This procedure is called an emergency hysterectomy. A delay or failure to perform an emergency hysterectomy can have major consequences for the mother because uterine damage from placenta accreta is notorious for causing massive hemorrhaging, again because the blood vessels cannot contract. Medical malpractice cases involving placenta accreta often involve failures to delays in performing an emergency hysterectomy.
The appropriate path when a placenta accreta is diagnosed with a sonogram, is to deliver the baby by Caesarean section. This is one of the biggest failures that lead to placenta accreta related lawsuits.
Placenta Accreta Malpractice Verdicts & Settlements
Summarized below are verdicts and reported settlements from medical malpractice cases which involved mismanagement placenta accreta.
- $24,500,000 Verdict (Florida 2021): 34-year-old mother suffered significant blood loss due to a placenta accreta during a Cesarean section delivery, requiring surgery, including a hysterectomy, and resulting in cardiogenic and pulmonary shock with hypoxia, multiorgan failure and death. The lawsuit contended the doctors negligently failed to follow up an ultrasound identifying a possible placenta accreta, failed to follow up and obtain a transvaginal ultrasound as recommended, then failed to prepare for and treat the placenta accreta when it occurred.
- $5,500,000 Settlement (Arizona 2019): The defendants were allegedly negligent in not performing a laparotomy or hysterectomy immediately upon diagnosing the placenta accreta. As a result, the 30-year-old mother suffered a hysterectomy, systemic failure to nearly all major organs, heart surgery, respiratory distress syndrome, temporary kidney shutdown.
- $3,500,000 Settlement (New Jersey 2018) : 35-year-old pregnant plaintiff is diagnosed with placenta previa which is obstructing her cervical opening. Her condition makes vaginal delivery unsafe so she goes to hospital for planned C-section. Baby is safely delivered via C-section but thereafter doctors discover placenta accreta – a dangerous complication in which the placenta attaches too deeply to the uterus wall. Plaintiff’s placenta percreta severely damages here uterus and an requires an emergency hysterectomy. Instead of immediately performing or even preparing for the hysterectomy, however, the OB/GYN delays for almost an hour for help from another doctor. Meanwhile plaintiff’s uterus is hemorrhaging causing major blood loss but doctors do nothing to replenish blood or fluids. By the time they finally start the hysterectomy plaintiff suffers severe brain damage which leaves her cognitively impaired and unable to speak or walk. She sues all of the doctors and the hospital for negligent care in failing to immediately preform the hysterectomy and failing to replenish blood while they delayed. The doctors point blame at each other but eventually agreed to settle the case for $3,350,000 which is split between the OB/GYN, anesthesiologist and the hospital.
- $15,500,000 Verdict (Illinois 2013): decedent, 33-year-old woman with history of prior C-sections, gets clean bill of health from her prenatal exams and goes to hospital for planned C-section delivery. Doctor makes low transverse incision for C-section and ends up cutting into the placenta which is abnormally positioned and attached extremely deep and actually penetrating through the uterine wall. Massive hemorrhage results and doctors are not fully prepared for emergency hysterectomy and don’t have enough blood on hand to replace blood she loses. She eventually dies after 6 days in the ICU. Her husband sues the hospital and doctors for negligently failing to diagnose the placenta accreta / percreta in advance and not being properly prepared for emergency hysterectomy which would have saved her life. Doctors deny that placenta accreta could have been diagnosed in prenatal exams and claim she her death is the result of allergic reaction which prevented blood from clotting. Jury in Chicago awards $15.5 million.
- $950,000 Verdict (New York 2009): 43-year-old mother delivers third child safely via planned C-section but placenta does not detach normally and severe case of placenta accreta is diagnosed. Massive hemorrhaging occurs after removal of placenta which calls for an immediate emergency hysterectomy. Doctors and hospital are not fully prepared and more than 30 minutes passes before they even begin the hysterectomy and mother dies. Her estate sues doctors and hospital for negligent delay in performing the hysterectomy. At trial it comes out that doctors or hospital employees may have deliberately attempted to alter medical records after the fact to cover up the delay. Jury in Kings County awards $950,000.
- $650,000 Verdict (New York 2009): 35-year-old plaintiff has successful vaginal delivery of baby and is discharged from hospital. Soon after getting back home she suffers from significant vaginal bleeding but after physical examination and sonogram her OB/GYN cannot determine the source of cause of the bleeding. Several days pass and follow up sonograms reveal an abnormal mass in the uterine cavity so she goes back to the hospital twice for hysteroscopy procedures. Thereafter she has suffers severe, life-threating vaginal hemorrhage and undergoes an emergency hysterectomy. During the hysterectomy doctors realize that she had suffered placenta accreta that went unnoticed and this was the cause of her bleeding. She sues doctors for negligently failing to diagnose and treat the placenta accreta during delivery which she claims would have avoided the hysterectomy. In defense doctors insist that emergency placenta accreta would have led to hysterectomy even if timely diagnosed. Jury in Manhattan awards $650,000 in damages.
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