By PPH Foundation

Postpartum haemorrhage (PPH), or excessive bleeding after childbirth, can become particularly dangerous when the placenta grows too deeply into the wall of the uterus, a condition known as placenta accreta spectrum (PAS). When the placenta fails to separate normally after delivery, attempts to remove it can trigger severe bleeding, putting a mother’s life at risk and requiring urgent, specialised medical care.

A review published in Nature Reviews Disease Primers in June 2025 describes placenta accreta spectrum as an increasingly common pregnancy complication associated with serious bleeding and damage to nearby organs. The condition includes placenta accreta, where the placenta attaches abnormally to the uterine muscle, placenta increta, where it grows into the muscle, and placenta percreta, where it penetrates through the uterine wall and may reach surrounding organs.

The placenta normally attaches to the uterus during pregnancy and separates after the baby is born. In women with placenta accreta spectrum, this separation can be difficult or impossible without intervention. The risk is particularly high when the condition is not identified before delivery and attempts are made to remove the placenta manually, potentially causing major haemorrhage.

Research identifies previous caesarean delivery as a major risk factor, particularly when the placenta lies low in the uterus or covers the cervix, a condition known as placenta praevia. A 2025 review by researchers from the University of Nairobi and other institutions, published in the International Journal of Gynecology & Obstetrics, examined cases managed at a Kenyan tertiary referral hospital and highlighted the serious complications associated with placenta accreta spectrum, including severe bleeding, blood transfusion, injury to nearby organs and, in some cases, hysterectomy.

However, the condition can sometimes go undetected during pregnancy, making antenatal assessment and appropriate imaging important. Ultrasound can help identify women at increased risk, allowing health professionals to plan delivery in a facility equipped to manage complex obstetric emergencies.

According to a 2025 systematic review published in JAMA Network Open, there is broad agreement among clinical guidelines on the importance of specialised expertise and antenatal management of placenta accreta spectrum. The review also identified gaps in guidance, particularly concerning some surgical approaches and the management of women in low- and middle-income countries, where access to specialist services and resources may be limited.

For Dr Kireki Omanwa, the President of KOGS and a Co- Lead of the End Postpartum Haemorrhage Initiative, the condition reinforces the importance of strengthening health systems to prevent avoidable maternal deaths. “Ending postpartum haemorrhage is not about doing more, it is about aligning evidence, systems, and people to do what works, together.”

Managing placenta accreta spectrum requires coordinated care involving obstetricians, anaesthetists, experienced surgeons, midwives and blood transfusion services. Depending on the severity of the condition and the individual circumstances, treatment may involve a planned caesarean birth followed by removal of the uterus, while carefully selected cases may be considered for uterus-preserving approaches under specialist supervision.

For health facilities, preparedness means recognising risk factors early, ensuring access to skilled personnel and blood products, and developing a clear delivery and emergency management plan. These measures are particularly important because severe bleeding can develop rapidly and may require urgent surgery and substantial blood transfusion.

As efforts to end preventable maternal deaths from PPH continue, greater awareness of placenta accreta spectrum can help health workers identify high-risk pregnancies and plan safer deliveries. Early recognition, specialist care and reliable emergency response remain essential to reducing the risk of severe haemorrhage and improving outcomes for mothers.

References

1. Jauniaux, E., Aplin, J. D., Fox, K. A., et al. (2025). Placenta accreta spectrum. Nature Reviews Disease Primers, 11, Article 40. https://doi.org/10.1038/s41572-025-00624-3
2. Bonanni, G., et al. (2025). Guidelines on Placenta Accreta Spectrum Disorders: A Systematic Review. JAMA Network Open, 8(7), e2521909. https://doi.org/10.1001/jamanetworkopen.2025.21909
3. World Health Organization. (2025). Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage. World Health Organization. https://www.who.int/publications/i/item/9789240115637
4. Image by magnific</a>