Placenta Accreta Clinic

Froedtert & MCW deploys a multi-disciplinary team approach to address the unique risks and challenges a pregnant woman and her unborn child face with the complex diagnosis of Placenta Accreta Spectrum (PAS). The team is led by Drs. Garrett Fitzgerald, MD and Meredith Cruz, MD, MPH, MBA, specialists in Maternal-Fetal Medicine. Prenatal care visits are coordinated with an increased focus on ultrasound diagnosis and pre-delivery surgical planning. The main risk to the mother and unborn child is associated with heavy bleeding, usually at the time of delivery. In response to this risk our team relies on the expertise of several subspecialties to tailor a plan for the safest birth outcome possible. These specialties include Obstetric Anesthesia, Gynecologic Oncology, Urogynecology/Urology, Interventional Radiology and Neonatology. Close collaboration with the only Level 1 Trauma Center in Southeast Wisconsin as well as the Wisconsin Blood Institute on campus allows our team is able to offer an unparalleled care response to the potential for catastrophic blood loss. Our goal is utilize an innovative, evidence-based approach tailored to each patient’s presentation of this diagnosis to ensure the best outcome possible. Thereby, we intend to serve as a regional center for excellence caring for women from all over Wisconsin.

What is Placenta Accreta Spectrum?

Placenta Accreta Spectrum (PAS) is a condition when the placenta is abnormally attached the uterus (“womb”). To best describe this condition it is important to understand the job of the placenta. The placenta is a temporary organ that is formed at the same time as the developing baby; it is the physical connection between the mother and the baby and it is responsible for delivering nutrients to the baby, filtered from the mother’s blood. In normal pregnancies the placenta separates from the wall of the uterus within a few minutes after delivery of the baby.

In the instance of PAS, the placenta abnormally invades into the wall of the uterus and because of this it does not separate from the uterus after delivery of the baby. This is associated with very serious bleeding to the new mother.

How does this happen? Who is at risk?

The placenta attachment to the uterine wall is a highly coordinated process and requires signals, much like traffic signs, to tell the placenta where to go and when to stop attaching. When a patient has had surgery on her uterus those “traffic” signals are impaired and so the placenta can continue to grow into areas of the uterus that it shouldn’t.

Patients who have had prior surgeries such as cesarean delivery, myomectomy (fibroid removal), dilation and curettage (D&C) are most commonly at higher risk. The more surgeries in these categories that a patient has had further increases that risk.

How is Placenta Accreta Spectrum Diagnosed?

The gold standard for diagnosis of PAS is ultrasound. Typically the diagnosis is made during the second trimester ultrasound known as the fetal anatomic survey. Our approach typically utilizes an MRI scan once a diagnosis is made in order to assess severity of the diagnosis and guide which additional surgical services may best serve that patient. MRI is a radiation-free imaging technique, therefore it is 100% safe for a developing fetus.

We typically perform ultrasounds at monthly intervals to assess the health and well-being of the baby.

How is pregnancy managed differently?

The most critical change in pregnancy care for patients with PAS diagnoses is careful assessment of bleeding. Prenatal visits may occur in more frequent intervals to assess for maternal symptoms.

Next, we typically plan for a preterm delivery (between 34-36 weeks). This timing is directed by national guidelines and balances the risks of prematurity for the newborn against the risk of severe bleeding affecting the mother and newborn. Delivery is nearly always by cesarean delivery, but cases are assessed individually.

Cesarean delivery may occur in the main OR setting in order to unite all the surgical and medical specialties needed to safely care for the mother-baby. Our NICU team attends and evaluates the newborn immediately with all pediatric equipment necessary to care for the baby at every level.