Placenta Accreta Is One of the Most Dangerous Obstetric Complications, and It’s Often Identifiable Before Delivery.
Placenta accreta spectrum (PAS) disorders, including accreta, increta, and percreta, occur when the placenta abnormally implants into or through the uterine wall, most commonly in the setting of a prior uterine scar (cesarean section, myomectomy, or uterine surgery). The result, if not anticipated and planned for, is catastrophic hemorrhage at the time of delivery that can require emergency hysterectomy, massive blood transfusions, ICU admission, and carries a significant risk of maternal death. The fetus is also at risk from the complications of maternal hemorrhagic shock and emergency delivery.
Critically, placenta accreta is not a surprise finding in the majority of cases; it can be identified on prenatal ultrasound or MRI in women with risk factors. When the diagnosis is made or suspected, the standard of care requires referral to a maternal-fetal medicine specialist, delivery at a center of excellence with multidisciplinary surgical capability, and a carefully planned cesarean hysterectomy if needed. When these steps are not taken, the preventable harm that results to the mother and baby can be devastating.
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Negligence Theories in Placenta Accreta Cases
- Failure to screen for accreta on ultrasound in a patient with prior cesarean section and an anterior low-lying placenta or placenta previa
- Failure to refer a high-risk patient to maternal-fetal medicine for accreta workup
- Failure to counsel the patient about the risk of accreta, the implications for delivery planning, and the possibility of hysterectomy
- Delivery at a facility without the blood products, interventional radiology support, urology, and surgical team required to manage an accreta-complicated birth
- Failure to activate a multidisciplinary team when accreta is diagnosed or suspected
- Inadequate intraoperative management leading to uncontrolled hemorrhage and maternal injury
Consequences of Mismanaged Placenta Accreta
When accreta is not identified and managed before delivery, the operative scenario becomes an unplanned, chaotic hemorrhagic emergency. The consequences for the mother can include: emergency hysterectomy resulting in infertility; massive blood transfusion and its complications; injury to adjacent organs (bladder, ureter, bowel) during emergency surgery; prolonged ICU admission; and death. For the baby, emergency delivery in the context of massive maternal hemorrhage creates substantial risk of Hypoxic Ischemic Encephalopathy (HIE) and other injury.
Frequently Asked Questions
What causes a birth injury?
Birth injuries can occur for a number of different reasons. In some cases the child’s head is too large to fit through the mother’s pelvis. Other times the placenta become detached prematurely or the umbilical cord is compressed or twisted. Also, when a physician uses forceps or a vacuum during a vaginal birth, injury to the brain can result. In many of these instances time is of the essence. The doctor is responsible for knowing when a cesarean section is necessary in order to avoid injury to the child.
There is no way to completely eliminate the risk of birth injury, but some risk factors that can lead to trouble during child birth are drawn out labor, atypical positioning of the baby, too much Pitocin given to the mother, larger than average sized baby, premature birth and the use of forceps or vacuum.
Expectant parents tend to anticipate a relatively smooth birth process and a healthy baby. In the majority of cases this will be the outcome. Sadly, there are some instances where birth injury and possible lasting effects will result. If you or a loved one has a child affected by a condition that was caused by birth injury and you believe it resulted from negligence on the part of the medical staff, we can offer a free assessment of your case. We have extensive knowledge in the areas of birth injuries and medical malpractice, and will be happy to advise you of your options moving forward.
What is birth injury malpractice?
Medical malpractice relates to birth injury in cases where the medical professional charged with you and your baby’s care fails to provide appropriate care during pregnancy, during the delivery process, or shortly after the child is born.
To better understand birth injuries and how they can be caused by medical and/or nursing mistakes, first you need to understand the concept of medical malpractice. The following will explain what medical malpractice means, statistics and some general tips for selecting the right doctor and avoiding medical mistakes.
A birth injury is an injury that can happen prior to birth, during the labor and delivery process, or in the neonatal or “newborn” period. Injuries that occur during the prenatal period can be attributed to untreated infection such as Group B Streptoccoccus, placental insufficiency or abruption, and preterm birth causing respiratory distress and brain hemorrhage.
Labor and delivery injuries can be caused from a health care provider failing to recognize fetal distress during labor signaling decreased oxygen being delivered to the baby’s brain resulting in injuries to brain structures responsible for movement, cognition, vision, swallowing, and coordination. Additional injuries that occur during labor and delivery can be related to CPD or “cephalo-pelvic disproportion” whereby the baby’s head is too large to fit through the mother’s pelvis during the birthing process.
Did you know?
Rasansky | McKenzie Law negotiated a settlement of more than $10 million on behalf of an infant who was diagnosed with cerebral palsy as a result of medical and nursing malpractice. We have also obtained numerous multi-million dollar settlements for children who suffered other types of birth injuries caused by medical malpractice.
What should I do if my child suffered a birth injury?
The first and most important issue to deal with after a birth injury is caring for the health of the baby and the mother. Get advice, treatment, and support from medical professionals you trust, and do not be afraid to get a second opinion. Also, be sure to take advantage of counseling and therapy options if you or your family needs help processing what happened.
After the health and well-being of your family is under control, you may wish to speak with a Dallas birth injury lawyer. A medical malpractice attorney can help you better understand what caused your baby’s injury, collect the evidence of the case, and enumerate your legal options if you choose to take action.
A birth injury is traumatic for the entire family – and one mistake in labor and delivery can lead to a lifetime of medical costs, nursing care, disability, and therapy. If you believe that your child’s injury was caused by negligence, you owe it to your family to ensure that the person or hospital responsible for your child’s injury pays for the consequences of their negligent actions. If someone else caused the injury, why should the financial burden be placed on your family?
Is my child entitled to compensation?
Typically, it is not the parent but the child who will be awarded compensation, as it was the child who was injured by the doctor’s negligence making the child entitled to compensation. If you win your birth injury claim/lawsuit against the doctor/hospital, compensation is usually delivered in the form of a trust. Keep in mind though that parents can sue for emotional distress—or if the mother was also injured because of the doctor’s behavior. If the child dies because of a doctor’s negligence, the compensation goes to the parents.
What are the main types of birth injuries?
There are many types of injuries that can occur during pregnancy and delivery, ranging from minor to severe. Among the most common types of birth injuries are:
- Cerebral palsy.
- Brachial plexus injuries (Erb’s palsy, Klumpke’s palsy).
- Infections (B strep, meningitis).
- Baby brain damage.
- Bruising and bleeding beneath the cranial bones.
- Bone fractures and nerve damage (often to the upper arm).
- Shoulder dystocia.
- Spina bifida.
- Folic acid deficiency, anemia.
- Persistent Pulmonary Hypertension.
- Blood flow and/or oxygen being cut off to the baby during delivery (causing anoxic brain injury, hypoxia, birth asphyxia, or perinatal asphyxia).
- Wrongful death.
Will my child's birth injury go away?
Birth injuries do not always lead to serious and lasting harm to the child. Many of them will heal on their own with no medical intervention. In some incidences, however, birth injuries result in chronic conditions such as cerebral palsy, Erb’s palsy, or Klumpke’s palsy.
Of these, cerebral palsy is probably the most concerning, as the others do sometimes improve or resolve. Cerebral palsy can affect coordination, reflexes, gait, muscle tone, and mental capabilities. In a study among six countries, the incidence of cerebral palsy was estimated to be between 2.12 – 2.45 cases per 1000 births.
If you’re concerned whether or not your child’s injuries will improve, the best course of action is to speak to your pediatrician. If you’d like to have an attorney look into the facts of your case, call us at (214) 651-6100.
Placenta Accreta FAQs
Is placenta accreta always preventable?
The condition itself is not preventable, but its consequences often are, if it is identified before delivery and managed at a facility with the appropriate resources. The legal question is whether the risk was assessed, the diagnosis was pursued when clinically indicated, and delivery was appropriately planned. When a patient with multiple prior cesarean sections and a low-lying anterior placenta delivers at a community hospital without accreta screening and then experiences life-threatening hemorrhage, the failure of planning is the actionable negligence.
What is the difference between accreta, increta, and percreta?
These terms describe increasing depths of abnormal placental invasion. In accreta, the placenta attaches to the myometrium without invading it. Increta invades the muscle. In percreta, the most severe form, the placenta grows completely through the uterine wall and may invade adjacent organs such as the bladder or bowel. Percreta carries the highest risk of surgical complication and maternal death, and requires the most extensive multidisciplinary planning.
If you suffered serious harm from placenta accreta that was not identified or planned for appropriately, our expert birth injury attorneys at Rasansky | McKenzie Law will evaluate your case for free. Call today.
