A young mother had to undergo a hysterectomy after losing more than five litres of blood due to a life-threatening undiagnosed pregnancy condition.
Chloe Robinson recalls medical staff at Burnley Hospital descending into “emergency and panic” when she lost a dangerous amount of blood following an emergency caesarean section during the birth of her daughter Poppy in July 2024.
Unbeknown to her, Ms Robinson, then aged 32, was suffering from Placenta Accreta Spectrum (PAS), a pregnancy condition that can cause life-threatening complications.
Medics carried out a hysterectomy on Ms Robinson to stop the bleeding and she and Poppy both survived the medical emergency.
But the mother-of-two said the ordeal caused her “shock after shock” – and that an earlier diagnosis would have allowed her to prepare for the trauma.
She is one of thousands of women who have PAS, a condition affecting one in every 272 births. According to campaign group Action for Accreta, 61 per cent of women go undiagnosed before delivery and 64 per cent require emergency surgery.
Survivors are now campaigning for greater surveillance and training in PAS across maternity services. They are also calling for changes to medical guidelines so women are diagnosed antenatally and are therefore more prepared for potential blood loss during delivery.
PAS occurs when the placenta grows too deeply into the wall of the womb during pregnancy, meaning it doesn’t separate easily during delivery. When doctors attempt to remove the placenta after birth, a woman with this condition can haemorrhage within minutes.
The exact cause of PAS is unknown but previous caesarean sections, IVF, placenta praevia (which is low-lying placenta covering the cervix), a maternal age of 35 or above and abnormalities of the womb are all risk factors, according to the NHS.
The condition, which doesn’t always cause noticeable symptoms during pregnancy, is usually diagnosed during routine ultrasound scans.
However, Action for Accreta warns PAS can be difficult to reliably detect on ultrasound. In many cases, even advanced imaging such as MRI cannot confidently confirm or rule it out, which is why they believe more training is needed.
Ms Robinson had a previous caesarean and was diagnosed with placenta praevia early in her pregnancy – meaning she was at an increased risk of PAS – but her condition was not spotted in an ultrasound and she said she did not receive further checks.
“I had intermittent bleeding throughout, but medics said you've got a low-lying placenta, sometimes it bleeds. It was all dismissed,” she claims.
“You’re not going to prevent accreta from happening. But the point is trying to minimise the trauma of it. I would have still had accreta, I may still have had a hysterectomy. But the management of it has made the whole thing so much more traumatic,” she added.
Treatment for PAS usually involves a planned caesarean delivery. Women may deliver their baby earlier, be closely monitored for infection, be prepared for a blood transfusion and, if the placenta cannot be safely removed, a hysterectomy may be performed to control the bleeding, according to information provided by Royal Berkshire NHS Foundation Trust.
Following her traumatic birth, an internal investigation by East Lancashire Hospitals Trust said it would update its guidance to refer at-risk women to a foetal medicine specialist to be “actively screened” for PAS.
The trust apologised to Ms Robinson for not diagnosing the condition antenatally and acknowledged that an earlier diagnosis would have “psychologically prepared” her for a hysterectomy.
Pete Murphy, chief nurse and executive lead for maternity services at East Lancashire Hospitals NHS Trust, agreed PAS “requires specialist assessment and careful antenatal diagnosis” and said the Trust has worked to strengthen the early identification, referral and management of women at risk of PAS.
“We continue to work closely with colleagues across maternity, fetal medicine, obstetrics, anaesthetics, surgery and imaging to improve the coordination and delivery of care for women where the condition is suspected or confirmed,” he added.
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Dr Chineze Otigbah, obstetrician and fetal medicine expert at Queen’s Hospital, Romford, told The Independent :“It’s not the condition that kills, it's what happens when you try and mess around with it.”
She added that screening people early in pregnancy and flagging those at a higher risk, such as those who have had caesarean, could prevent the need for emergency hysterectomies and “massive blood loss”.
In a separate case, a mother-of-four told how she was already in a high-risk category after three previous caesareans, but was only diagnosed after she asked the sonographer if she had PAS.
Kimberely Littler, 40, from Glasgow, explained that the question triggered an urgent transfer, an eight-hour operation, hysterectomy and neonatal admission that may have saved her life.
“It's very scary, just how one little decision or me deciding to speak up could have really saved my life,” she told The Independent. “I could have been dead, don’t know if Eli would have survived, my three girls could have been motherless if it wasn't spotted.”
Ms Littler stressed medical staff including sonographers need to be better trained to spot PAS to avoid “unnecessary death and unnecessary trauma.”
Katie Buckingham, from Surrey, said she was “mentally broken” when she gave birth to her daughter Tilly in February 2025 and felt "abandoned" when she didn’t receive the support she needed.
She was suspected of having PAS throughout her pregnancy and when she delivered her daughter in a planned caesarean under general anaesthetic she was told it was not PAS because her placenta was “whole”.
A week after the birth, the 34-year-old suffered a secondary haemorrhage, a uterus infection and developed sepsis. She was brought back into surgery to remove tissue and blood clots from her uterus.
The products removed were never sent to histology. In the weeks that followed, she continued to be unwell and at six-weeks postpartum retained placenta was found, requiring yet another serious surgery.
“If tissue had been sent for testing, it may have spared me the prolonged trauma of repeated A&E visits, further surgery, and weeks of uncertainty,” she said.
“What I needed was not just treatment each time I collapsed into a crisis. I needed joined-up care, specialist understanding, and somewhere to feel safe.”
Ms Buckingham’s placenta was never tested for the condition – the only way a diagnosis can be confirmed – but a specialist consultant confirmed it was likely PAS after all.
Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists (RCOG) explained guidance on PAS will soon be updated.
She said: “PAS can cause serious complications during pregnancy and birth, so early detection and appropriate clinical management is vital.
"Our understanding of this condition has grown significantly in recent years and the upcoming RCOG clinical guideline on PAS and placenta praevia, expected to publish in June, reflects the most up to date evidence and provides advice on the management and care of women with these conditions.
"This guidance aims to support teams to deliver the highest standard of care to every woman affected.”
Donald Peebles, national clinical director for maternity at NHS England, said: "Placenta accreta spectrum is rare, but when it does happen it can lead to very heavy bleeding, which is why identifying women at higher risk early in pregnancy is so important.
"Maternity teams are supported by clear clinical guidance to spot the warning signs and, where needed, refer women to specialist NHS centres with experienced multidisciplinary teams and access to critical care.
"Our focus is on making sure every woman receives safe, expert and compassionate care throughout their pregnancy and labour.”
