At the 2014 annual meeting of the Radiological Society of North America, Dr. Patrick Nicholson described a novel approach to treating placenta accreta. Nicholson and his multidisciplinary team of specialists at Cork University Hospital in Cork, Ireland, used a two-step approach to treat women with the disorder. As a result, mothers’ lives were saved, their fertility spared, and none of the babies suffered ill effects of the treatment.
Placenta accreta is diagnosed when ultrasound scans indicate the placenta is attached to the muscular wall of the uterus rather than to the tissue that lines the uterus during pregnancy. The condition is most often diagnosed in the second and third trimesters although some cases are detected earlier. Without medical intervention, massive hemorrhaging during childbirth is common.
According to Nicholson, “Massive obstetric hemorrhage is the number one cause of maternal mortality worldwide and abnormal placental implantation is a major risk factor for this.” Nicholson cited three risk factors that increase the likelihood of abnormal placental implantation:
- Maternal age
- History of C-section delivery
- In vitro fertilization (IVF)
Since the 1970s, the rate of placenta accreta diagnoses has risen sharply, according to the American Congress of Obstetricians and Gynecologists (ACOG):
- 1 case in every 4,027 pregnancies in the 1970s
- 1 in 2,510 pregnancies in the 1980s
- 1 in 533 pregnancies from 1982 to 2002
The rise in abnormal placental implantation parallels the trend for delaying childbirth, the rise in the number of C-sections performed, and perfection of IVF procedures.
The 2012 ACOG recommendations for treating placenta accreta call for planned delivery via C-section along with the removal of the uterus (hysterectomy) while the placenta is still attached to the uterine muscle. ACOG reaffirmed this recommendation in 2014. Nicholson’s approach eliminated the need for hysterectomy in most cases.
Since 2009, Nicholson’s obstetric team included an interventional radiologist who inserted balloons into the iliac arteries of the pelvis of 21 patients with placenta accreta immediately before C-section deliveries were started. When needed, these balloons were inflated to stop the flow of blood into the pelvic area, thereby eliminating the risk of hemorrhage. Inflation was required in 13 of the 21 deliveries and only two of them required a hysterectomy. The mean age of the 21 mothers in Nicholson’s study was 35.
Nicholson said that “without the balloons, many more of the patients would likely have required a hysterectomy.” His medical team reported no adverse effects resulting from this two-step interventional approach for the mothers or their babies.
Nicholson’s is “the first group to report on the fetal outcomes associated with prophylactic internal iliac artery balloon placement.” He identified the clear “need for more research in this field” and stressed the value of the multidisciplinary approach in managing high-risk pregnancies of this nature.
Sources:
- Radiological Society of North America. "In patients with placenta accreta, interventional radiology procedure preserves uterus." Medical News Today. MediLexicon, Intl. 5 Dec. 2014. Web. 11 Dec. 2014.
- The American College of Obstetricians and Gynecologists. “Committee Opinion: Placenta Accreta.” ACOG. The American Congress of Obstetricians and Gynecologists. Jul. 2012. Web. 11 Dec. 2014.