Placenta Accreta: Multiple C-Sections Can Kill Mother

PHOTO: Placenta Accreta on the Rise: Life-threatening condition associated with repeat Caesarians.
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Barbara George nearly hemorrhaged to death while doctors delivered her fifth child at Hackensack Medical Center in New Jersey -- and that was in 2010, not 1910.

The stay-at-home mother from South Orange was diagnosed with placenta accreta, a life-threatening condition where the placenta grows into the uterine wall and sometimes beyond.

George, 38, had the most invasive form -- percreta -- and the placenta dangerously penetrated the entire uterine wall and had attached itself to her bladder.

Once a rare event that affected 1 in 30,000 pregnant women in the 1950s and 1960s, placenta accreta now affects 1 in 2,500 pregnancies, according to a 2007 report in the Journal of Obstetrics and Gynecology. In some hospitals, the number is as high as 1 in 522.

And doctors say the main reason is the dramatic rise in the number of Caesarian sections -- about 38 percent of all pregnancies in New Jersey, the second highest in the nation.

"The rule of thumb is if you have one C-section and the placenta sits right on top of the scar, the risk of placenta accreta is 25 percent," said Dr. Abdulla Al-Khan, director of the Division of Fetal Medicine and Surgery at Hackensack University Medical Center.

"If you've had two previous C-sections the risk is close to 50 percent and three, it's 75 percent and four, it's invariably closer to 100 percent."

Al-Khan and his team performed seven hours of complex surgery on George, first delivering the baby in a sternum to pubic bone vertical incision, then cauterizing veins to detach the placenta from the bladder and finally a hysterectomy.

"I always thought it would never happen to me," said George, who delivered at 34 weeks gestation. "Mother nature protects the uterus," said Al-Kahn. "The Nitabach layer kind of prevents the placenta from invading the uterine wall."

But a Caesarian, or any kind of surgery, including an abortion or a D& C, can destroy that layer allowing the placenta to invade the body cavity.

The risk of the mother dying in childbirth has been cut by 99 percent since the turn of the 20th century, from 850 deaths per 100,000 births in 1900 to 7.5 in 1982, according to the Centers for Disease Control and Prevention.

But between 1998 and 1999, the maternal mortality rate rose by 13 percent and and continued to creep upwards, according to the CDC.

New Jersey saw 40 maternal deaths last year, according to Dr. Joseph Apuzzio, chair of the state's morbidity and mortality review committee and an obstetrician at New Jersey Medical School in Newark.

More Women Demand Caesarians

Doctors are also seeing other complications in pregnancy that increase maternal risk: more diabetes and preeclampsia, a higher number of twins and multiples and advanced maternal age.

"When we natural age, we have more medical conditions," said Al-Kahn. "Pregnancy always exacerbates things."

Babies are also larger, compared with a century ago, even though the size of the female pelvis has not changed at all, he said. A rise in cases of placenta accreta due to multiple Caesarians is also contributing to maternal death statistics.

"Now patients have a right to make shared decisions with their doctor," he said. "It's self-empowerment. If I can have a tummy tuck and rhinoplasty, why can't I have a Caesarian delivery?"

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