In a detailed response to recent media coverage, Professor Eric Jauniaux, a key developer of the Royal College of Gynaecologists' guidelines, has clarified critical aspects of placenta complications, specifically addressing placenta previa and placenta accreta spectrum (PAS). His insights stem from both professional expertise and personal experience, as he encountered placental retention during his son's birth, a condition affecting approximately one in 100 deliveries.
Understanding Placental Complications
Placental retention, often confused with PAS in medical statistics, occurs when the cervix closes prematurely after childbirth, leading to uterine atony and postpartum haemorrhage. This condition is a significant concern in obstetrics due to its potential for life-threatening bleeding and traumatic impact on families and healthcare providers.
In contrast, placenta accreta spectrum involves abnormal attachment of the placenta to the uterine wall, typically necessitating surgical intervention such as resection or hysterectomy. Professor Jauniaux emphasizes that PAS is frequently linked to placenta previa accreta in patients with a history of low-segment caesarean sections, accounting for over 90% of cases.
Debunking Misconceptions
Contrary to some reports, PAS does not directly endanger the fetus unless maternal complications force premature delivery. The professor clarifies that PAS results from placental development within a previous uterine scar, not from invasive tissue growth akin to cancer. He notes that upper-segment PAS is rare and often undetectable in routine ultrasounds, making accurate diagnosis challenging.
While commending Dr. Chineze Otigbah's management of a specific case involving Amisha Adhia, Professor Jauniaux cautions against viewing such instances as common or directly correlated with rising caesarean rates. He reassures patients that the NHS has implemented a robust screening program and care plan for at-risk individuals, following the 2018 RCOG guidelines, to enhance safety and outcomes in childbirth.
