I've had three Caesareans and am now 28 weeks pregnant. I'm in hospital because I had some bleeding and the placenta is stuck over the scar. What does this mean?

Your risks are of placenta accreta (placenta stuck to the scar), increta (placenta growing in the scar) and percreta (placenta growing right through the full thickness of the scar). Good statistics are difficult to come by, but the risk of placenta accreta is somewhere between 10 and 30% if you've had a previous Caesarean and the placenta is now sited over the scar. Of course there is a chance that you placenta isnít stuck at all, but just happens to be implanted over the scar, in which case the Caesarean should not be too complicated. A colour Doppler scan by a specialist would be very useful but rarely gives a 100% answer, an MRI scan can give more information and is routine practice in some units. Most obstetricians would suggest a GA Caesarean and would warn you of hysterectomy. There are other surgical procedures that could be performed (such as vascular occlusion techniques) before resorting to hysterectomy and your obstetric team may also involve interventional radiologists and vascular surgeons in planning your delivery.
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