Specialized, Interdisciplinary Care for Placenta Accreta

Lehigh Valley Health Network (LVHN) provides expert care for people with placenta acreta spectrum (PAS), a pregnancy complication in which the placenta inappropriately grows into the muscle of the uterus or beyond.

PAS can occur if prior surgeries such as cesarean sections damage the tissue that would later develop into the decidua during a growing pregnancy, according to Jhenette Lauder, MD, with LVPG Maternal Fetal Medicine.

“In the absence of this barrier,” Dr. Lauder says, “the placenta can grow into the muscle, preventing normal cleavage following delivery. Should the placenta be forcibly removed in these cases, there is a significant risk for massive hemorrhage and maternal morbidity.”

Most people with PAS are asymptomatic, but a cesarean scar ectopic pregnancy is thought to be a direct precursor to accreta if it progresses in pregnancy, Dr. Lauder says.

“Anyone who has undergone multiple C-sections and/or uterine surgeries with an anterior placenta or previa may require treatment for PAS,” she says. “Others who may have PAS include those with ultrasound findings that are concerning for abnormal placenta or cesarean scar ectopic pregnancy.”

People with this condition may undergo these surgical procedures:

• Cesarean hysterectomy (C-section with immediate hysterectomy)
• Bilateral salpingectomy (removal of fallopian tubes)
• Cystoscopy with bilateral ureteral stent placement (removed at end of case)
• Uterine artery embolization (UAE before hysterectomy to decrease blood flow to uterus and thus decrease surgical blood loss)

“In uncomplicated cases, delivery typically occurs between 34 and 35 weeks,” Dr. Lauder notes.

Doctors and clinicians in the maternal fetal medicine complex obstetric surgical program treat people with PAS, as do doctors and clinicians from gynecology, urology and interventional radiology. The neonatal intensive care unit and neonatology treat the babies.

“Our patients do quite well,” she says, noting that William Scorza, MD, obstetrics, maternal fetal medicine (perinatology), “has developed an excellent program with great collaborative care among all subspecialty services.”

Dr. Lauder says that LVHN’s well-established and specialized approach exclusively uses ultrasound for diagnosis and has high accuracy with posthysterectomy pathology.

The majority of people treated for PAS at LVHN have less than average blood loss, and most do not require time postoperation in the intensive care unit, she notes.

“Many are discharged in stable condition within three to five days following delivery,” she says. “Neonatal outcomes are also excellent.”

Importantly, she adds, “referral should be done as soon as possible to determine a diagnosis.”

They are available throughout the region: