More pregnancies complicated by morbidly adherent placenta

As the number of caesarean sections have increased — up to 32.8 percent of deliveries in 2012 were C-sections, according to the most recent CDC data — a severe medical condition, morbidly adherent placenta, is becoming more common in pregnant women. Baylor College of Medicine doctors have devised a unique approach to treating the condition that is proving beneficial to patients.

Caesarean sections leave scars, not only on the skin but also on the uterus. A morbidly adherent placenta occurs when the placenta attaches and imbeds inside the previous caesarean section scar and muscle. In some cases, the placenta will grow outside of the uterus and attach to surrounding areas, like the bladder or abdominal muscles.

This dangerous condition can lead to a hemorrhage and is fatal in 4 to 8 percent of cases.

“Diagnosis before delivery is key to allow time for planning and preparation,” said Karin Fox, M.D., assistant professor of maternal-fetal medicine in the department of obstetrics and gynecology at Baylor.

Ultrasounds performed around 18 to 28 weeks typically show if a morbidly adherent placenta is present in a patient. An MRI also can provide a look at the uterus, however, neither of these methods is 100 percent accurate.

Baylor doctors have developed a checklist to help identify women who are at risk. They also make identifying and treating morbidly adherent placenta a team effort by including those in gynecologic oncology, urology, anesthesiology and the blood bank.

“We see more success when working as a team,” said Fox. “We are actively researching this condition to develop ways to provide the most comprehensive treatment.”

Additionally, doctors are seeing success by taking a wide surgical approach when cutting around the placenta, said Concepcion Diaz-Arrastia, M.D., associate professor of gynecologic oncology in the department of obstetrics and gynecology at Baylor. This wide approach helps limit the blood loss in the patient.

In the last 12 months Baylor doctors working at the Texas Children’s Pavilion for Women, where both Fox and Diaz-Arrastia see patients, have seen 27 cases of morbidly adherent placenta, as patients from across the United States are sent to Texas Children’s for treatment once they have been diagnosed with a morbidly adherent placenta.