Placenta Accreta, Kim Kardashian West's Pregnancy Complication, Explained

PSA: Pregnancy can be dangerous.
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In a characteristically soul-baring interview with C Magazine, reality TV queen Kim Kardashian West revealed that she suffered from a potentially life-threatening condition called placenta accreta when she was pregnant with her daughter, North. What's more, her doctors are concerned she could go through it again with the upcoming birth of her second child.

“If the placenta grows a little bit deeper than it did last time, then [the doctors] are prepared to have my uterus removed, which is a little scary for me,” West told C Magazine’s Amanda de Cadenet.

Placenta accreta is a condition in which the placenta grows too deeply into the mother’s uterus, becoming inseparable from the uterine wall. After birth, when the placenta is supposed to be expelled from the uterus, it fails to detach. Removing it completely can cause massive blood loss and damage to internal organs. West said that the surgery to remove North’s placenta left a small hole in her uterus.

This is scary stuff, and West’s doctors are correct in warning her that they may have to perform a hysterectomy once her child is born. The condition is the number one reason that women who have Caesarean births also end up having their uterus removed, according to the American College of Obstetricians and Gynecologists. And mothers with placenta accreta are at higher risk of death at childbirth, “despite optimal planning, transfusion management, and surgical care.”

Women who have had a previous Caesarean delivery or other uterine surgeries are at higher risk for the condition, as the placenta can implant improperly over the uterine scar.

The ACOG reports suggest rising rates of Caesarean births are in turn responsible for an increase in placenta accreta. In the 1970s, the disorder occurred in only 1 out of 4,027 pregnancies, and in the 1980s, the rate increased to 1 in 2,510. By 2002, the rate of placenta accreta grew to 1 in 533 pregnancies. Other risk factors for placenta accreta have grown over the decades, such as IVF pregnancies and older maternal age, according to a 2012 study. Placenta previa, in which the placenta implants over the cervix, is also a risk factor for placenta accreta.

There are actually three types of placenta accreta, although the term is commonly used to describe all of them. In the top left section of diagram above, the placenta attached normally to the surface of the uterus. In the bottom left of the diagram, the placenta has attached to the myometrium, or the middle layer of the uterus, made up of smooth muscle. In placenta increta (top right), the placenta is embedded even more deeply into the myometrium. Finally, in placenta percreta, the placenta has penetrated the uterus completely, sometimes attaching to other nearby organs.

The best way to treat placenta accreta is to diagnose it early, through ultrasound or MRI, so that an OB/GYN can plan for the birth by making sure there’s a sufficient supply of blood available, as well as bring in surgeons and other specialists to assist if needed.

The ACOG also notes that generally, the safest way to deliver a child whose placenta is embedded in the mother’s uterus is to deliver it earlier than full-term and remove the uterus entirely after the child is born, without bothering to detach the placenta from the uterus first. However, as with West's first delivery, that isn’t a desirable option for women who want to continue having more children.

Trying to preserve fertility after placenta accreta is a complex process, and it doesn't always succeed. A 2009 study examined the cases of 76 women with suspected placenta accreta and found that while 42 opted to have their uterus removed during childbirth, 15 tried to have the placenta removed surgically to preserve their ability to have children in the future. However, all 15 of these cases resulted in an immediate hysterectomy because the surgeons could not control the bleeding.

It's a set of challenges no mother wants to face, but hopefully West's publicity of the issue will bring greater awareness for the many women who contend with this condition.

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