Common Questions about Placenta Accreta Spectrum (PAS):

Do all women diagnosed with accreta have to have a hysterectomy after delivery?

A hysterectomy (removal of the womb) is a highly effective treatment for minimizing hemorrhage in PAS, however it is not always necessary. In general, large accretas, incretas and percretas are most safely managed with a hysterectomy. However, small or “focal” accretas can sometimes be removed without a hysterectomy. In rare cases, patients and the team may agree that leaving some or all of the accreta in the uterus (rather than removing the uterus) is a reasonable option. These decisions are complicated and require extensive discussion with an experienced Maternal Fetal Medicine physician.

Do all women diagnosed with accreta have to be delivered before their due date?

The development of problem blood vessels in placenta accreta increases and the pregnancies progresses, and therefore in general, delivery of patients with PAS is planned around 34 to 36 weeks of gestation. The Accreta Team will decide on the optimal timing of delivery and discuss this with the patient. If a woman has significant vaginal bleeding during the third trimester, recommendations for hospitalization or earlier delivery may happen.

Do all women diagnosed with accreta have to be under general anesthesia for either part of all of the delivery and hysterectomy?

What type of anesthesia required for delivery is individualized and dependent on the specific circumstances. A combined spinal-epidural anesthesia is often used at the beginning of the surgery to allow the patient to be awake for the baby’s delivery. However, if long, complicated surgeries are required then general anesthesia may be necessary for safety and comfort either at the start of the surgery or after the baby is delivered. Our patients meet with our Anesthesiologists to discuss the specifics of their anesthesia plans prior to delivery.

Are women able to breastfeed after a cesarean hysterectomy (removal of the womb after delivery of the baby)?

Most mothers are able to try to breastfeed, and our hospital’s lactation specialists are available for consultation. Sometimes breast milk may take longer to come in after surgery, however women who desire to breastfeed are well supported. Some women who have very complicated surgery and recovery may not be able to breastfeed, but their babies will be given formula or donated breast milk and will continue to develop well.

How long do I have to stay in the hospital after my delivery?

Every case is different, but the typical hospital stay is between four and five days. However, depending on the severity of the PAS, patients may have to stay longer.