I am the lead developer of the Royal College of Gynaecologists’ Green-top guidelines on placenta previa and placenta accreta spectrum (PAS), referenced in your article (Campaign urges NHS to improve diagnosis of potentially life-threatening childbirth condition, 18 February). I also have personal experience of placental delivery complications, as when my son was born, his placenta got stuck inside the womb of his mother after his birth (placental retention).
Placental retention is due to the premature closure of the cervix after the birth of the baby, and is a leading cause of uterine atony and postpartum haemorrhage, affecting around one in 100 births.
Placenta accreta happens when part of the placenta is abnormally attached to the uterine wall, requiring a surgical resection or hysterectomy. Placental retention and PAS are often mixed in statistics and audits, as they are both associated with difficult placental delivery and life-threatening haemorrhage, and are traumatic for the parents and obstetric staff.
PAS is due to the development of the placenta inside a previous uterine scar, and there is no evidence that it is due to abnormal placental tissue invading a normal uterine wall, like a cancer. PAS is also not directly associated with a risk to the foetus, as suggested in your article, unless the baby has to be delivered prematurely due to a maternal complication.
Over 90% of patients with a PAS present with placenta previa accreta and a history of low-segment caesarean section. PAS of the upper segment of the uterus is exceptional, and small spots of PAS in the upper segment are unlikely to be detected during routine ultrasounds.
In the case mentioned in your article, Dr Chineze Otigbah certainly managed Amisha Adhia very well, but these cases should not be considered common or associated with the rise in caesareans. Patients should be reassured that the NHS has developed a screening programme and care plan for patients at risk of PAS, following the publication of the 2018 version of the RCOG guideline.
Prof Eric Jauniaux
EGA Institute for Women’s Health, University College London
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