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ICAN Accreta Awareness Month – What is Placenta Accreta?
By The Well-Rounded Mama, August 26, 2013
Placenta Accreta, Part One: What Is Accreta?
Read the full article here.
Summary:
Placenta accreta comes in three levels of severity ─ accreta, increta, and percreta.
Thankfully, most accretas don’t involve an increta or a percreta. However, even without these severe forms, an accreta is still a very serious complication that has the potential to become life-threatening.
Fortunately, foreknowledge of an accreta, careful management protocols, and being in the right delivery setting can significantly lower the risk of mortality and morbidity. So if you have been told that you have an accreta, don’t panic. Chances are that you and your baby will be okay.
However, you need to know that a significant blood loss is likely, a transfusion may be needed, and a hysterectomy is a distinct possibility (depending on the severity of the accreta). In the most severe cases, nearby organs may be damaged as well. Management and delivery at a large regional hospital with OBs that are very experienced with dealing with accretas will optimize your chances for the best outcomes.
Sadly, the incidence of accretas has increased in parallel with the rising cesarean rate. This is because scarring and damage to the uterine lining during a cesarean predisposes to abnormal placentation. Indeed, the more cesareans a woman has, the higher her risk for placenta accreta.
Some risk factors for accretas cannot be controlled, but a high underlying cesarean rate is a risk factor that is preventable on a population-wide basis, and routine repeat cesareans is a risk factor that is highly preventable on an individual basis.
Placenta accreta is an extremely serious complication that is becoming all too common. A casual attitude towards cesareans, an over-utilization of them in low-risk mothers, and a lack of access to Vaginal Birth After Cesarean (VBAC) is part of the cause.
This is yet another reason why reducing the cesarean rate and keeping access to VBAC is so important.
ICAN Awareness Month – Placenta Accreta: Multiple C-Sections Can Kill Mother
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 cesarean 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 cesarean, 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 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.
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 cesareans 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 cesarean delivery?” Al-Kahn jump-started the high-risk program at Hackensack after one of his patients nearly died in 2004. The woman had had only one previous cesarean and the placenta in her second pregnancy had implanted right on top of her scar.
“She started bleeding at 35 weeks and we took her into the operating room to deliver the baby,” said Al-Kahn. “It got to the point that she went into shock and needed 33 units of blood. We intubated her and she was three days on a ventilator. She lost half of her bladder and it took 12 hours in the operating room to save her life. I said to myself, ‘God save this individual so she can live to be with her two kids and her husband,” said Al-Kahn. “I never wanted that to happen again.”
Since the program was started in 2005, Al-Kahn has seen more than 60 patients with the risky condition. Both mortality and the number of transfusions have dropped, he said. George, who had four other high-risk pregnancies because of preeclampsia and diabetes, was referred to Hackensack after her own doctor saw something ominous on an MRI.
“I could just see her trying to maintain a professional exterior and see she had more concerns than she wanted to let on,” said George. When she learned she had placenta accreta, she prepared for the worst and got her affairs in order. “It was very difficult,” said George. “I’m the type of person that tends to think it’s not going to happen to me. I didn’t want to deal with the what-ifs. But we had to have that conversation. It was so surreal.”
Her doctor sent her straight to Hackensack where George was given magnesium and steroids to encourage the baby’s lung development. In the middle of New Jersey blizzards on Dec. 27, Hannah was delivered by a long cesarean cut from the sternum to the pubic bone. There was never any danger to the baby, who was born in 45 minutes, but doctors were worried about George, cauterizing every blood vessel using hypothermic techniques so they could slowly peel away the placenta from the bladder.
“I feel so grateful,” she said of her now 3-month-old daughter. “Hannah is amazing and has really brought this family together in such a way, I can’t explain it.” But George said that her experience is a warning to other women who opt for cesarean sections when surgery is not medically necessary. “A cesarean should never be done to accommodate your schedule or because of your fears of pain,” she said. “It’s an unnecessary trauma to the body and it should not be treated as an alternative to natural childbirth.”
#ICANsavelives
Reposted with permission from ABCNews
ICAN Accreta Awareness Month – Welcome to October 2017!
- We will be sharing graphics about accreta everyday. Follow us on Facebook, Pinterest, Twitter, and Instagram and share in your circles.
- We will be sharing informative articles.
- We will be sharing birth stories and pictures of accreta moms.
- On October 15th, we will be remembering and honoring the moms and babies that we lost to accreta, a very real risk with this condition.
Cesarean Survival Essentials: postpartum binding
“Cesarean Survival Essentials: postpartum binding” by Wendy Foster
This article is a reprint from the Winter 2015 edition of The Clarion, the official publication of ICAN. Become a member today to support ICAN and to subscribe!
As a former volunteer EMT, I was taught to ensure the scene was safe before entering; scanning the environment and weighing the risks before proceeding. We all do this as mothers, during labor and beyond. Most women don’t go into labor feeling like rock stars in amazing shape. We go into labor already tired from nine months of pregnancy, with separated abdominals and a body that’s out of alignment from carrying around a new little human.
One out of three women in the U.S. give birth by cesarean. Many experience infections at their incision, back problems, pubic symphysis, and pelvic floor issues. Hence, the postpartum scene is not safe to enter. But we have no choice. We must proceed and immediately call for backup.
There are so many articles, websites, and online forums with recommendations on the best ways to recover from a cesarean. Perhaps you’ve heard some of these words of wisdom: “Don’t lift anything heavier than your baby.” “Keep your incision clean and dry.” “Manage your pain.” “Eat healthy foods and get moving.” “Wait! Don’t do too much too soon.” While these are helpful hints, they fail to take into consideration that your body needs support, both emotionally and physically, to heal.
Fortunately, there are amazing resources like ICAN that provide emotional support during the recovery period. However, as far as physical recovery, I’d like to suggest that the most important support that you can provide for yourself is as simple as practicing abdominal binding.
Binding around the globe
Postpartum binding is practiced in many cultures throughout the world. For centuries, women have found that binding provides support and stability for the back and core muscles, which are often weak and likely separated after pregnancy. U.S. women wore girdles or corsets, which acted as binders, through the 1970s. Many Asian cultures believe postpartum binding is a way of re-containing and providing extra warmth for healing the internal organs. Supporting the core muscles physically, through binding, is key in recovery from a cesarean.
Begin binding ASAP
Abdominal binding can be used throughout pregnancy to support the growing baby and uterus. After the birth of your baby, Dr. Lara Williams, Oregon-based OB/GYN and mom of two, recommends binding as soon as one to two days postpartum to help support the core and the cesarean scar.
Dr. Bucko, a Board Certified Plastic Surgeon, recommends binding immediately post-cesarean and for at least 3-6 weeks thereafter. Randomly selected patients who wore binders after a “tummy tuck” demonstrated an enhanced post-operative walking experience (faster recovery to ambulation) and reduction in stress and in pain. Dr. Bucko also notes that his patients experience a great sense of security and confidence while wearing their binders.
Binding promotes stability and recovery
One of the mamalates goals of restorative birth recovery is stability. I have found that postpartum binding can help the new mother maintain pelvic stability and reduce swelling, while protecting the scar and low back. One common trait that most women who birth via cesarean share is the need to lift with their shoulders and back, instead of their core. The shoulders and ribs slide up and round forward and the pelvis is tucked to protect the incision. This happens during nursing, feeding, lifting, and even sitting and can cause back, pelvis, and neck pain. It’s very challenging to engage the core to lift and carry after major abdominal surgery!
Binding is a very therapeutic solution for this. It provides support to a weak core, while reminding mom to retain her alignment, helping to stabilize the shoulder girdle and pelvis while providing manual support.
Binders come in many varieties
Although many insurance companies are now reimbursing for birth recovery items like abdominal binders, don’t feel that you need to go out and buy one that’s new and fancy! Remember, women have been binding for centuries using simple materials. Here are a few suggestions for items that you can use to bind or wrap for the first four weeks post-cesarean:
- Moby wrap baby carrier
- Jersey sheet/material
- mamalates essential abdominal binder
- Old yoga pants
- Hospital binder
If you decide to purchase a new binder, save your receipt and submit it to your insurance company for reimbursement—especially if you’ve met your deductible from surgery this year.
Cesarean binding tips and tricks
If you have a binder available immediately postpartum, you can place a lightly wrapped soft ice pack between your scar and the binder to hold the ice in place. A light wrap is all you need post-cesarean if your abdominals are not separated. If you’ve determined that you have an abdominal separation of two or more fingertips wide, you’ll need a more therapeutic/structural binder that can help bring the muscles back together.
Whether you have a scheduled or unplanned cesarean you need to keep the postpartum scene safe, call in your back up, and remember:
- Ask your healthcare provider for a binder before you leave the hospital—don’t assume they will offer one to you.
- Also ask them what stretches you CAN do within the first 6 weeks to help facilitate recovery.
- Have your insurance pay for the binder or reimburse you if you pay for one out of pocket.
- Share this information with your friends and sisters so they are prepared.
WENDY FOSTER is the founder of the mamalates method and the master trainer for all mamalates workshops and licensing programs. An internationally certified Pilates instructor, pre/post fitness specialist, and birth recovery expert, Wendy has been teaching Pilates since 1999 and practicing yoga for nearly two decades. She has had a cesarean and a VBAC. She owns a studio in Southeast Portland, OR. Contact her at wendy@mamalates.com or visit mamalates.com. Find a mamalates class near you!