High risk for bleeding – Risk factors prior to delivery should cue action to obtain blood work, large bore IV access, available blood, etc. If diagnosis has been made, cesarean section should be planned in a tertiary facility equipped with all necessary preparations to handle a massive hemorrhage emergency.

Normally, the placenta is separated from the uterine myometrium by a decidual layer. When the baby is delivered, this layer allows easy detachment and delivery of the placenta.

Placenta Accreta Vera – When the dicidua is absent, the placenta attaches directly to the myometrium, making separation difficult and heightening risks of bleeding.

Placenta Increta – If the placenta has chorionic villi invading the myometrium (just a deeper invasion of the placenta into the myometrium).

Placenta Percreta – If the placenta has completely surpassed the myometrium and is now invading tissues such as the bladder or GI tract.

Diagnosis may be made by obtaining an ultrasound. If abnormal, an MRI may give a more definitive diagnosis. Catching these conditions, however, is not always done previous to delivery. Diagnosis often becomes suspected at delivery if the placenta does not detach, but becomes definitive by a laparotomy.

Risk factors include: Uterine fibroids, previous cesarean section (increasing risk with greater number of cesarean sections), history of postpartum hemorrhage, multiparty.