Campaign urges NHS to improve diagnosis of potentially life-threatening childbirth condition | Childbirth
Amisha Adhia will launch a campaign calling on the NHS to do more to diagnose the condition and save lives after five hospitals failed to detect she was suffering from a rare but potentially fatal birth complication.
Pregnant women are at a much higher risk of developing placenta accreta spectrum if they have previously given birth by caesarean section or undergone IVF treatment.
If it is not detected before the woman goes into labor, she risks having to undergo an emergency hysterectomy or bleeding due to a serious hemorrhage.
The NHS says one in 300 to 2000 women develop placenta accreta. Doctors warn that the number of women at risk is increasing due to the increasing number of babies being born by caesarean section (45%) rather than vaginally (44%) in the UK.
“Placenta accreta can cause catastrophic bleeding within minutes if not expected,” said Adhia, who founded the research team. Action for Accreta campaign with her husband Nik. She said she feared women with the condition might go undetected because so few NHS obstetricians make a correct diagnosis, exposing women and their babies to serious risks.
Placenta accreta occurs when the placenta, which provides nutrients and oxygen to the fetus, grows too deep into the wall of the woman’s uterus and blocks part or all of the cervix. This makes the usual separation of the placenta from the uterus during labor difficult.
Obstetricians at five London hospitals told Adhia she did not have the condition. However, consultant gynecologist Dr. Chineze Otigbah revealed that it was. His intervention meant that Adhia, 36, received the necessary care when she gave birth to her daughter Ishaani under doctor’s care at the Queen’s hospital in Romford, north-east London, last September.
“I’m alive today because Dr Otigbah recognized the danger and took action. I was told over and over again that my risk of placenta accreta was almost zero because my placenta was up, not down. But it was there, and it was deeply invasive.
“I was reassured that I would be in danger. I was carrying a disease that could kill us both. I felt unheard. I thought I was going to die.”
Adhia lost almost a liter of blood while giving birth to Ishaani via Caesarean section; this was much less common than other births involving placenta accreta, but she suffered no serious complications. Her experience of being “assessed, disregarded and ignored” by five hospitals, which she says “ignored” her concerns that she had placenta accreta, led her and her husband to raise awareness of the condition.
Approximately 40 women who experienced disruptions during pregnancy or birth due to placenta accreta not being diagnosed contacted the couple after seeing their posts on social media.
There are no figures to show how often placenta accreta develops or causes complications as the NHS does not record the information. Even annual MBBRACE-UK There are no details in the report regarding maternal health and birth outcomes. Studies in the US and Israel suggest the prevalence may be as high as 1 in 111 pregnant women.
Eight baby and maternal health groups, including the Birth Rights and Birth Trauma Association, supported the campaign. Separately, baby charities Tommy’s and Sands welcomed it in a joint statement as it “helps highlight significant gaps in awareness, surveillance and learning” about serious complications of pregnancy.
Current guidance Placenta accreta and placenta previa, which can also cause massive blood loss, are “associated with high maternal and neonatal morbidity and mortality”, says the Royal College of Obstetricians and Gynecologists (RCOG), which represents obstetricians. He added that rates of both have increased and will continue to increase as a result of the increase in caesarean sections, the rise in the average maternal age and the increased use of “assisted reproductive technology”.
Adhias recently gave evidence to Valerie Amos’s inquiry into maternity care in England, which was ordered last year by health secretary Wes Streeting, who is also the couple’s MP. They asked Amos to include recommendations in his report that the NHS should do more to detect placenta accreta.
“I am deeply concerned about women falling through the gaps in our current system,” Otigbah said.
“The main risk factors for PAS are caesarean section and IVF, which are greatly increased. [But] The NHS has failed to adapt to this reality. “Not every hospital has PAS specialists, so subtle warning signs can be missed.”
The couple said they wanted the RCOG, which updated its guideline, to include recommendations on the diagnosis and treatment of the atypical form of PAS seen in Amisha.
An RCOG spokesperson said: “Placenta accreta spectrum is a rare but potentially very serious complication of pregnancy in which the placenta attaches too deeply to the wall of the uterus, which can cause heavy bleeding and trauma at birth.
“According to current data, it is seen in between 1 in 300 and 1 in 2,000 pregnancies, but its incidence is increasing in the UK and around the world.
“We know that early identification of placenta accreta through pregnancy scans and appropriate follow-up imaging is extremely important so that care can be carefully planned with appropriate specialist teams, improving outcomes for women and babies.”
It was stated that the updated guidelines are expected to be published later this year.
NHS England did not respond directly to the concerns raised. Prof Donald Peebles, national clinical director for maternity, said: “Placenta accreta spectrum is rare, but when it occurs it can cause potentially life-threatening haemorrhage, so it is crucial to identify women at high risk early in pregnancy.
“Maternity teams are trained to look for warning signs that women who have previously had a caesarean are most at risk, and patients are referred to specialist NHS centers where necessary.”
