Thirty-three weeks into her first pregnancy, Christie Gummow went into labor. Despite the early delivery, she and the baby were fine, except that Gummow’s placenta — the organ that develops in the uterus during pregnancy and supplies the baby with oxygen and nutrients — did not detach like it is supposed to.
“It was kind of strange, but no one seemed too focused on it,” Gummow, now 40, recalled. Her OB-GYN removed it manually, and that was that.
Then, three weeks later, Gummow spiked a fever and was overcome by nausea, like she had the flu. Her doctors had her come back in for an ultrasound, then immediately scheduled her for surgery. Part of her placenta had stayed in her body, attached to her uterine wall, and that was making her very sick.
Even at that point, however, Gummow wasn’t aware that any kind of formal diagnosis existed for what had happened to her, nor did her doctors bring her placental issues up when she got pregnant again several months later. Because she’d delivered early before, she was considered high-risk and saw multiple specialists throughout her pregnancy. But those specialists were focused on one thing: Preterm birth, which indeed happened again when Gummow went into labor at 30 weeks.
Once again, the labor was relatively smooth, except that Gummow’s placenta did not detach after the baby was delivered.
And once again, she was taken in for surgery.
“When I came out, I was in recovery and I was apparently talking and doing OK, but my OBGYN — who delivered both of my babies and knew me pretty well — picked up that my speech pattern was changing, and I was slurring some words,” recalled Gummow. “She knew something was happening, and they rushed me back in.”
Gummow had an amniotic fluid embolism, a rare and extremely dangerous condition that happens when amniotic fluid or other fetal materials enter a woman’s blood, often because of a breakdown in the placental barrier.
“I almost died. My blood pressure dropped, I went into heart failure and I ended up in the ICU on every machine you can think of,” Gummow said. “It took a while to figure out exactly what happened.”
The answer she was given?
A rare, but increasing condition
During pregnancy, the placenta basically serves as the fetus’ lifeline. It grows in a woman’s body, providing oxygen and nutrients and removing waste.
After vaginal deliveries, women must also then deliver the placenta, often called the afterbirth. It’s a process that may take up to 20 minutes or more, and is aided along by continued uterine contractions — and sometimes comes as a shock to women who think their work is done. (During a C-section, it is simply removed.)
With placenta accreta, however, some or all of the placenta stays attached, which happens when the placenta grows too deeply into the uterine wall. The American College of Obstetricians and Gynecologists (ACOG) refers to it as “placenta accreta spectrum,” noting the variations in how, exactly, the placenta sticks to the body. For example, there is placenta increta (when the placenta invades the muscles of the uterus). And placenta percreta (when it grows entirely through the uterine wall).
“The risks to women with a placenta accreta are significant: life-threatening bleeding, hysterectomy, bladder injury, blood transfusion [and] ICU admission,” Dr. Mallory Hoffman, a maternal-fetal medicine physician at the Fetal Center of Cincinnati, told HuffPost. “But fortunately, [it is] uncommon if a woman has no risk factors.”
Uncommon, but on the rise.
According to ACOG, studies from the 1970s and 1980s put the rates of placenta accreta at about 1 in several thousand births. A 2016 study suggests the current rate may be closer to about 1 in 270 — an increase ACOG said is likely due to a change in risk factors, specifically, in C-section deliveries. Although most women who deliver via C-section will never have placenta accreta, it is one of the strongest risk factors for the condition — and C-section rates have increased in the U.S. now accounting for more than 30% of all births. Other risk factors include higher maternal age, having had a prior pregnancy and variations in placental positioning during pregnancy.
“We’re an interesting patient population,” said Kristen Terlizzi, an accreta survivor who is a founding director of National Accreta Foundation, a non-profit that, among other things, advocates against C-section overuse. “We’re so aware of both the risks and the benefits of Cesarean [delivery]. Many of us are not making it through childbirth without access to a Cesarean, and yet at the same time we’re aware of the potential downhill risks. So in my work, I’m advocating for both sides of the spectrum: access to Cesarean when it’s needed, and Cesarean reduction at the same time.”
Spreading awareness to save lives
Most women diagnosed with placenta accreta in pregnancy are advised to deliver via C-section, often with an immediate hysterectomy. Trying to remove the placenta can lead to hemorrhaging, which is why doctors often opt to just remove the entire uterus.
“There may be ultrasound findings prior to delivery that make the obstetrician more concerned for the possibility of an abnormal placental attachment, such as an inability to visualize the normal uterine wall behind the placenta, bulging of the placenta into the bladder, collections of blood in the placenta (called placental lakes), and increased blood flow to the placenta and uterine wall near the area of prior surgery,” Hoffman said.
“Making the diagnosis — or strongly suspecting it — prior to delivery is optimal, because it allows the obstetrician to prepare the operating room staff and have blood products available in cases of heavy bleeding,” she said.
Yet ACOG said a high number of undiagnosed cases continue, perhaps in part because women are not referred to specialists who have experience spotting signs of accreta on ultrasound images.
Even women who have experienced significant placenta-related complications before say they weren’t sufficiently warned about the risk in subsequent pregnancies. Women like Jannel Brichta, who had placenta complications after all three of her deliveries, but to her knowledge was never given any kind of official diagnosis.
After her first delivery, her OBGYN manually removed her placenta; after her second, she bled for two months before her doctors had her back in for surgery to remove part of her placenta, which they had not realized was still inside her. And after her third, Brichta was rushed into the operating room for emergency surgery as she began to hemorrhage, requiring several blood transfusions.
“I never knew this could happen to you. I never knew your placenta could basically sh*t out on you, and get stuck or infused with your uterus,” Brichta told HuffPost.
“It’s mindboggling to me doctors couldn’t tell if this would happen — or not —before my baby’s birth,” she said. Brichta took pains to say that she was not knocking her doctors, whom she credits with saving her life. But she cannot believe she had not heard of placenta accreta at any point during her pregnancies — particularly after her first or even her second birth experiences.
And advocates say that is a problem ― lack of awareness puts women’s lives at risk.
“We have to make sure that folks understand what this condition is, what the risk factors are for it, and how it’s skyrocketed over the past 30 years,” said Terlizzi.
“One of the most overwhelming things we hear in the accreta community,” she continued, “is that nobody knows what this condition is until they get it.”