I have had two children. After the first birth, I had some hemorrhaging a month after delivery. The doctors thought that possibly a piece of placenta was still in there. After my second child, the placenta would not detach and they did surgery to remove it. They said it was placenta accreta and I was lucky not to have a hysterectomy. If I have another child, will this condition get worse? I know that the placenta can grow deep into the tissues. What may be the chances of the placenta growing even deeper the next time? It seems that it is getting progressively more invasive each time.

J.K.

Placenta accreta is when the placenta adheres abnormally to the uterine wall and does not separate easily after delivery. Prior uterine surgery (cesarean section, D&C, myomectomy) or a placenta previa (low-lying placenta) are the most common reasons for a placenta accreta. If the placenta actually invades into the uterine wall it is called placenta increta, and if it penetrates all the way through the uterus it is called placenta percreta. Each of these conditions can lead to hemorrhage after delivery. Often, the only way to control the bleeding associated with placenta increta or percreta is to perform a hysterectomy after the baby is delivered.

Once a woman has been diagnosed with placenta accreta, it is likely to recur in subsequent pregnancies, especially if the placenta is located in the same spot. It often is more invasive and adherent with each subsequent pregnancy. Sometimes ultrasound can identify an placenta increta or percreta; in that case, a cesarean with possible hysterectomy may be planned so appropriate staff and blood are available.