Placenta accreta spectrum
The most serious long-term consequence of repeated cesarean.
In placenta accreta spectrum, the placenta grows into the uterine wall, usually into an old cesarean scar, and cannot separate after birth. Treatment is often removal of the uterus along with the placenta, with large blood transfusions.
The risk depends on two things together: how many cesareans you have had, and whether you have a previa now. Among 723 women who had a previa, the accreta risk was 3% at the first repeat cesarean, 11% at the second, 40% at the third, 61% at the fourth, and 67% at the fifth or more.
| Repeat cesarean number, with a placenta previa | Risk of placenta accreta |
|---|---|
| First | 3% |
| Second | 11% |
| Third | 40% |
| Fourth | 61% |
| Fifth or more | 67% |
This is the number to rememberA woman with three prior cesareans and a previa faces roughly a two in five chance of accreta, and a comparable chance of losing her uterus. This is the single strongest argument for thinking carefully about the first cesarean.
Where this comes from:
268. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-1232.
285. Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol. 2011;205(3):262.e1-262.e8.
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