Anyone do a transfer and carry successfully after a prior placenta accreta?

[Anonymous]

We are considering trying for a second--we have two embryos left in the freezer, and we'd really love to at least try to give DS a sibling. We know there are no guarantees--it took three years of failure and heartache just to get DS.

Anyway, DS came out perfectly, but the delivery got complicated fast. I had an accreta that had been missed. It was removed manually, took 2+ hours to remove, and I had multiple blood transfusions. It was an ordeal. I know of exactly one person who has conceived and carried to term after an accreta, and that was--randomly--Kim Kardashian, who after a second accreta, passed things on to a surrogate for number three. Not exactly helpful in terms of knowing what to expect.

My doctors say it's ok to try, though the birth would be very, very managed. What I want to know is whether anyone here had this experience before? Was it really possible? Did it change your pregnancy significantly? Do you have any advice? I'm a little terrified--not just of the potential heartache (which we know) but also of the unknown of having had a prior accreta.

In case this isn't familiar to you, an accreta is when the placenta actually grows into the muscle of the uterus, or--in even worse cases--into the organs beyond the uterus. It is TOTALLY different from placenta previa, which is a completely different condition.

TIA!

[Anonymous]

Are you consulting with an mfm about a plan to manage a second pregnancy? I would assume they would monitor you very closely via ultrasound.

[Anonymous]

Anonymous wrote:Are you consulting with an mfm about a plan to manage a second pregnancy? I would assume they would monitor you very closely via ultrasound.

Yes. I've actually requested that we do MRI's, which are the only shot of an ex ante diagnosis (and even then it could miss). The idea would be a planned c-section early (which I don't love, but I understand why spontaneous labor is problematic for surgical planning). Supposedly, they would have a bladder surgeon, kidney surgeon, bowel surgeon, someone to do a hysterectomy if needed, and an interventional radiologist in the room. Call me a skeptic, but this seems dubious to me that they can get this many GOOD people in one room on the same day. But that's what they said needs to happen.

Putting the delivery aside, what about the pregnancy? Or even implantation? Part of me wonders if an accreta reduces your chances of implantation due to microscopic scarring, but there are not good studies on this, and my doctor said the same--just no good studies.

[Anonymous]

Yes.

I had a similar situation except my accreta was discovered after a stillborn baby (conceived by medicated IUI). (More specifically, a vaginal birth of a stillborn baby, a placenta that wouldn't deliver and so an immediate D&C, then an infection a week later followed by another D&C, and then imaging that discovered an increta (i.e. the middle level of accreta). The accreta ultimately "cleared" on its own.) I was particularly aggressive in seeking out experts about how to have a living child after that experience. Here's what I did:

1. Imaging (including MRI and HSG) to confirm no residual tissue or problematic scarring before TTC. Consulted with MFM (in DC, see below, and also at the Brigham in Boston (they reviewed films, records, and I did a call with the MFM): https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/meet-our-team)

2. Conceived via medicated IUI again (this was where we were in our fertility process, so we weren't considering IVF yet).

3. Once I was pregnant, I was actively treated by an MFM (Dr. Pinckert at GWMFM; I cannot recommend him highly enough. I also saw Dr Gallagher as backup, then at GWMFM, now at GW, and he was also great.)

4. Of course my situation was monitoring for both the accreta and the baby's health given my history, but I had ultrasound (the high quality one at the MFM) and doppler every 2 weeks until 24 weeks, and then every week after that. That included looking for any indication of an accreta (this is a helpful summary:https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Placenta-Accreta)

5. Did an MRI around 30 weeks. It was done at Georgetown, and then also sent to the radiologists at the Brigham.

6. Planned c section at 40 weeks. A two person MFM team + fellow delivered. A friend who is a neonatal specialist was the pediatrician at delivery. The original plan was to have interventional radiologists in the room in case bleeding needed to be controlled, but given the confidence from the imaging, they had those people on call in the hospital but not in the room.

No complications at delivery. I bled a bit heavily during the c-section and it took a while for them to close during surgery, but not enough to transfuse. Normal c-section delivery, perfect DC.

I'm now in IVF trying to have another child and have gone through another round of MFM consults. The consensus at this point is that I am "normal" (though old!)

You're absolutely right that this is more art than science (the story with women's health in general), and the thing I found I relied on was working with the people who had the most accumulated experience of THIS thing. That's what expertise is in this field.

On the general scarring issue, I have a good friend who had scarring from a loss and infection (not accreta) who struggled with implantation from IVF after that. She also consulted with the Brigham team and was very happy.

Hope that helps. All the best to you.

[Anonymous]

Anonymous wrote:Yes.

I had a similar situation except my accreta was discovered after a stillborn baby (conceived by medicated IUI). (More specifically, a vaginal birth of a stillborn baby, a placenta that wouldn't deliver and so an immediate D&C, then an infection a week later followed by another D&C, and then imaging that discovered an increta (i.e. the middle level of accreta). The accreta ultimately "cleared" on its own.) I was particularly aggressive in seeking out experts about how to have a living child after that experience. Here's what I did:

1. Imaging (including MRI and HSG) to confirm no residual tissue or problematic scarring before TTC. Consulted with MFM (in DC, see below, and also at the Brigham in Boston (they reviewed films, records, and I did a call with the MFM): https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/meet-our-team)

2. Conceived via medicated IUI again (this was where we were in our fertility process, so we weren't considering IVF yet).

3. Once I was pregnant, I was actively treated by an MFM (Dr. Pinckert at GWMFM; I cannot recommend him highly enough. I also saw Dr Gallagher as backup, then at GWMFM, now at GW, and he was also great.)

4. Of course my situation was monitoring for both the accreta and the baby's health given my history, but I had ultrasound (the high quality one at the MFM) and doppler every 2 weeks until 24 weeks, and then every week after that. That included looking for any indication of an accreta (this is a helpful summary:https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Placenta-Accreta)

5. Did an MRI around 30 weeks. It was done at Georgetown, and then also sent to the radiologists at the Brigham.

6. Planned c section at 40 weeks. A two person MFM team + fellow delivered. A friend who is a neonatal specialist was the pediatrician at delivery. The original plan was to have interventional radiologists in the room in case bleeding needed to be controlled, but given the confidence from the imaging, they had those people on call in the hospital but not in the room.

No complications at delivery. I bled a bit heavily during the c-section and it took a while for them to close during surgery, but not enough to transfuse. Normal c-section delivery, perfect DC.

I'm now in IVF trying to have another child and have gone through another round of MFM consults. The consensus at this point is that I am "normal" (though old!)

You're absolutely right that this is more art than science (the story with women's health in general), and the thing I found I relied on was working with the people who had the most accumulated experience of THIS thing. That's what expertise is in this field.

On the general scarring issue, I have a good friend who had scarring from a loss and infection (not accreta) who struggled with implantation from IVF after that. She also consulted with the Brigham team and was very happy.

Hope that helps. All the best to you.

My goodness. Thank you doesn’t cover it. First of all, I am so sorry about your initial experience. That is truly heart-wrenching, and I am just so sorry.

Second, thank you for this wealth of information. I actually have consulted with Dr. Pinckert and plan to stay with him if I’m fortunate enough to get pregnant. If it’s not too much to ask, do you mind telling me if it was Dr. Pinckert who recommended the pre-TTC MRI? He did not recommend that for me despite the accreta. Perhaps it’s because my hysteroscopy looked ok after the delivery (apparently my OB saved my uterus), but a hysteroscopy wouldn’t spot microscopic damage. At the very least, I want to folllow up with him as we are considering a cycle very soon.

Third, and again, if I am bothering you, please ignore me, but I’m intrigued that you got to 40 weeks. Was that because of imaging? In my consultation, Dr. Pinckert suggested 38-39, which isn’t awful, but given that I carried DS to 41, and he was still a small fry, I’m a little nervous. Your story gives me reason, yet again, to follow up.

I am so glad that you’re c-section went well and without transfusion. Mostly I’m glad you got a healthy baby.

I confess I’m a little terrified of what my propensity toward accreta could mean for me, and now for a possible baby. I realize I was ignorant about the latter; no one ever mentioned that before. Yet another thing to follow up on.

Brigham in Boston is phenomenal (I used to live up there); I will look into that as well. Thank you again, truly.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes.

I had a similar situation except my accreta was discovered after a stillborn baby (conceived by medicated IUI). (More specifically, a vaginal birth of a stillborn baby, a placenta that wouldn't deliver and so an immediate D&C, then an infection a week later followed by another D&C, and then imaging that discovered an increta (i.e. the middle level of accreta). The accreta ultimately "cleared" on its own.) I was particularly aggressive in seeking out experts about how to have a living child after that experience. Here's what I did:

1. Imaging (including MRI and HSG) to confirm no residual tissue or problematic scarring before TTC. Consulted with MFM (in DC, see below, and also at the Brigham in Boston (they reviewed films, records, and I did a call with the MFM): https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/meet-our-team)

2. Conceived via medicated IUI again (this was where we were in our fertility process, so we weren't considering IVF yet).

3. Once I was pregnant, I was actively treated by an MFM (Dr. Pinckert at GWMFM; I cannot recommend him highly enough. I also saw Dr Gallagher as backup, then at GWMFM, now at GW, and he was also great.)

4. Of course my situation was monitoring for both the accreta and the baby's health given my history, but I had ultrasound (the high quality one at the MFM) and doppler every 2 weeks until 24 weeks, and then every week after that. That included looking for any indication of an accreta (this is a helpful summary:https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Placenta-Accreta)

5. Did an MRI around 30 weeks. It was done at Georgetown, and then also sent to the radiologists at the Brigham.

6. Planned c section at 40 weeks. A two person MFM team + fellow delivered. A friend who is a neonatal specialist was the pediatrician at delivery. The original plan was to have interventional radiologists in the room in case bleeding needed to be controlled, but given the confidence from the imaging, they had those people on call in the hospital but not in the room.

No complications at delivery. I bled a bit heavily during the c-section and it took a while for them to close during surgery, but not enough to transfuse. Normal c-section delivery, perfect DC.

I'm now in IVF trying to have another child and have gone through another round of MFM consults. The consensus at this point is that I am "normal" (though old!)

You're absolutely right that this is more art than science (the story with women's health in general), and the thing I found I relied on was working with the people who had the most accumulated experience of THIS thing. That's what expertise is in this field.

On the general scarring issue, I have a good friend who had scarring from a loss and infection (not accreta) who struggled with implantation from IVF after that. She also consulted with the Brigham team and was very happy.

Hope that helps. All the best to you.

My goodness. Thank you doesn’t cover it. First of all, I am so sorry about your initial experience. That is truly heart-wrenching, and I am just so sorry.

Second, thank you for this wealth of information. I actually have consulted with Dr. Pinckert and plan to stay with him if I’m fortunate enough to get pregnant. If it’s not too much to ask, do you mind telling me if it was Dr. Pinckert who recommended the pre-TTC MRI? He did not recommend that for me despite the accreta. Perhaps it’s because my hysteroscopy looked ok after the delivery (apparently my OB saved my uterus), but a hysteroscopy wouldn’t spot microscopic damage. At the very least, I want to folllow up with him as we are considering a cycle very soon.

Third, and again, if I am bothering you, please ignore me, but I’m intrigued that you got to 40 weeks. Was that because of imaging? In my consultation, Dr. Pinckert suggested 38-39, which isn’t awful, but given that I carried DS to 41, and he was still a small fry, I’m a little nervous. Your story gives me reason, yet again, to follow up.

I am so glad that you’re c-section went well and without transfusion. Mostly I’m glad you got a healthy baby.

I confess I’m a little terrified of what my propensity toward accreta could mean for me, and now for a possible baby. I realize I was ignorant about the latter; no one ever mentioned that before. Yet another thing to follow up on.

Brigham in Boston is phenomenal (I used to live up there); I will look into that as well. Thank you again, truly.

Yes, the MRI was at Pinckert's suggestion (though I didn't have a hysteroscopy post-delivery so maybe that matters?). And 40 weeks was rounding up - it was 39 and change at delivery. I found Pinckert really receptive to questions - there were definitely occasions when I raised something I'd read elsewhere and he'd either give me a really good explanation for why it didn't make sense (down to printing out medical studies for me) or say he thought it was a coin toss and he'd be happy to do the thing if that's what I really wanted.

To be clear, there was never any suggestion that the accreta caused me to lose the baby. They were two separate medical events, just with a really crappy double dose of bad luck.

It's totally reasonable to feel frightened, and at the same time I've come to believe that accretas happen far more than we realize (OB/GYN research being as limited as it is). I definitely coped by asking A LOT of questions and doing A LOT of research, so don't hesitate to do that if it's what works for you, and don't let anyone tell you otherwise. All the best to you.

[Anonymous]

Anonymous wrote:Yes.

I had a similar situation except my accreta was discovered after a stillborn baby (conceived by medicated IUI). (More specifically, a vaginal birth of a stillborn baby, a placenta that wouldn't deliver and so an immediate D&C, then an infection a week later followed by another D&C, and then imaging that discovered an increta (i.e. the middle level of accreta). The accreta ultimately "cleared" on its own.) I was particularly aggressive in seeking out experts about how to have a living child after that experience. Here's what I did:

1. Imaging (including MRI and HSG) to confirm no residual tissue or problematic scarring before TTC. Consulted with MFM (in DC, see below, and also at the Brigham in Boston (they reviewed films, records, and I did a call with the MFM): https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/meet-our-team)

2. Conceived via medicated IUI again (this was where we were in our fertility process, so we weren't considering IVF yet).

3. Once I was pregnant, I was actively treated by an MFM (Dr. Pinckert at GWMFM; I cannot recommend him highly enough. I also saw Dr Gallagher as backup, then at GWMFM, now at GW, and he was also great.)

4. Of course my situation was monitoring for both the accreta and the baby's health given my history, but I had ultrasound (the high quality one at the MFM) and doppler every 2 weeks until 24 weeks, and then every week after that. That included looking for any indication of an accreta (this is a helpful summary:https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Placenta-Accreta)

5. Did an MRI around 30 weeks. It was done at Georgetown, and then also sent to the radiologists at the Brigham.

6. Planned c section at 40 weeks. A two person MFM team + fellow delivered. A friend who is a neonatal specialist was the pediatrician at delivery. The original plan was to have interventional radiologists in the room in case bleeding needed to be controlled, but given the confidence from the imaging, they had those people on call in the hospital but not in the room.

No complications at delivery. I bled a bit heavily during the c-section and it took a while for them to close during surgery, but not enough to transfuse. Normal c-section delivery, perfect DC.

I'm now in IVF trying to have another child and have gone through another round of MFM consults. The consensus at this point is that I am "normal" (though old!)

You're absolutely right that this is more art than science (the story with women's health in general), and the thing I found I relied on was working with the people who had the most accumulated experience of THIS thing. That's what expertise is in this field.

On the general scarring issue, I have a good friend who had scarring from a loss and infection (not accreta) who struggled with implantation from IVF after that. She also consulted with the Brigham team and was very happy.

Hope that helps. All the best to you.

where did you deliver and who were the OBS who delivered or were you drs aside from Pinkertt? thanks!

[Anonymous]

Hi - original responder. I delivered with Pinckert and his then-colleague Gallagher at Silver Spring. But that was a while ago (2014). I don’t think Pinckert delivers anymore (or at least wouldn’t for a friend about 2 years ago).

And for anyone who finds this thread about the original OP’s questions, I ended up having DC #2 after IVF, no accreta or any other problems with that pregnancy or planned C delivery.