A Silent Threat to Childbirth: Placenta Accreta and the Urgent Need for Improved NHS Diagnosis
The joy of welcoming a novel child can quickly turn to terror when complications arise during childbirth. For Amisha Adhia, that fear became a harrowing reality when five hospitals failed to diagnose her with placenta accreta, a potentially life-threatening condition where the placenta grows too deeply into the uterine wall. Her experience has ignited a campaign, “Action for Accreta,” demanding improved diagnostic practices within the National Health Service (NHS) to prevent other women from facing similar, near-fatal outcomes. This growing concern comes as rates of placenta accreta spectrum (PAS) are rising, linked to increasing numbers of cesarean sections and in-vitro fertilization (IVF) treatments.
Placenta accreta is not a new phenomenon, but its increasing prevalence, coupled with reported diagnostic delays, is raising serious questions about maternity care in the UK. The condition can lead to catastrophic bleeding, requiring emergency hysterectomies or, tragically, resulting in maternal death. While affecting between one in 300 and one in 2,000 pregnancies, according to the Royal College of Obstetricians and Gynaecologists (RCOG), the numbers are climbing, prompting calls for greater awareness and specialized care. The story of Amisha Adhia underscores a critical gap in the system – a failure to recognize the warning signs and provide timely intervention.
The Perilous Journey of Diagnosis and the Launch of Action for Accreta
Amisha Adhia’s ordeal began during her second pregnancy. Despite a history of IVF treatment – a known risk factor for placenta accreta – her concerns were repeatedly dismissed by medical professionals. She recounts being reassured that her risk was minimal due to the position of her placenta, only to discover it was deeply invasive. “I was reassured into danger,” Adhia stated, as reported by The Guardian. “I felt ignored. I thought I was going to die.” She credits Dr. Chineze Otigbah with ultimately recognizing the severity of her condition and successfully managing her delivery with a planned cesarean section, limiting blood loss to approximately one liter.
Driven by her near-death experience, Adhia, along with her husband Nik, launched the Action for Accreta campaign. The campaign aims to raise awareness of the condition, advocate for improved diagnostic protocols, and ensure that women at risk are directed to specialized centers equipped to handle these complex cases. More than 40 families have already come forward with similar stories, highlighting a systemic issue within the NHS. The campaign has garnered support from leading charities, including Tommy’s and Sands, and parliamentarians, further amplifying its message.
Understanding Placenta Accreta Spectrum: Risks, Diagnosis, and Rising Incidence
Placenta accreta spectrum (PAS) encompasses a range of conditions where the placenta abnormally attaches to the uterine wall. The RCOG describes PAS as a “rare but potentially very grave complication of pregnancy” that can cause significant bleeding and trauma during childbirth. The spectrum ranges from placenta accreta, where the placenta attaches too deeply, to placenta increta, where it invades into the uterine muscle, and placenta percreta, where it penetrates through the uterine wall and potentially into adjacent organs.
Several factors contribute to the increasing incidence of PAS. The most significant is the rising rate of cesarean sections, which now account for 45% of births in England, surpassing vaginal births at 44%. IVF treatment is another key risk factor. However, Dr. Otigbah points out that the NHS has not adequately adapted to this changing landscape. “All hospitals do not have PAS specialists, so subtle warning signs can be missed,” she warned. Currently, NHS England does not maintain a dedicated registry for PAS, making it difficult to accurately track the condition’s prevalence and monitor outcomes. This lack of data hinders efforts to improve care and allocate resources effectively.
The Call for Systemic Change: Action for Accreta’s Demands
The Action for Accreta campaign is advocating for several key changes within the NHS. They are urging the RCOG to update its guidelines to better reflect the diverse presentations of PAS and to emphasize the importance of referring high-risk pregnancies to specialized centers. This would ensure that women receive care from experienced teams equipped to manage the complexities of the condition. Amisha and Nik Adhia recently testified before the inquiry led by Valerie Amos into maternity care in England, further highlighting the urgent need for reform.
The NHS acknowledges the seriousness of PAS and emphasizes its commitment to improving care. Professor Donald Peebles stated that identifying women at high risk during pregnancy is “so vital” due to the potential for life-threatening hemorrhage. He added that maternity teams are trained to recognize warning signs, particularly in women with a history of cesarean section, and to refer patients to specialized NHS centers when necessary. However, campaigners argue that this training is not consistent across all hospitals and that a more proactive and standardized approach is needed.
The Role of Ultrasound and Early Detection
Early detection is crucial in managing placenta accreta. The RCOG emphasizes the importance of utilizing ultrasound imaging during pregnancy to identify potential cases. However, interpreting these scans requires expertise, and subtle signs can be easily overlooked. Access to specialized ultrasound services may be limited in some areas, contributing to diagnostic delays. The Action for Accreta campaign is advocating for increased investment in training for sonographers and radiologists to improve the accuracy of PAS diagnosis.
Beyond the UK: A Global Perspective on Placenta Accreta Management
The challenges faced by the NHS in diagnosing and managing placenta accreta are not unique. Healthcare systems worldwide are grappling with the increasing incidence of this condition. However, some countries have implemented more robust screening programs and established specialized PAS centers, leading to improved outcomes. Learning from these international best practices could inform the development of a more effective national strategy for the UK.
For example, some hospitals in the United States have implemented multidisciplinary teams dedicated to managing high-risk pregnancies, including those with suspected PAS. These teams typically include obstetricians, maternal-fetal medicine specialists, radiologists, anesthesiologists, and neonatologists, ensuring comprehensive care. Advanced imaging techniques, such as MRI, are often used to confirm the diagnosis and plan for delivery.
Key Takeaways
- Placenta accreta is a serious, potentially life-threatening complication of pregnancy that is becoming increasingly common.
- Diagnostic delays are a major concern, with women often being misdiagnosed or having their concerns dismissed.
- The Action for Accreta campaign is advocating for improved diagnostic protocols, specialized care centers, and increased awareness of the condition.
- Early detection through ultrasound and MRI is crucial for effective management.
- The NHS needs to adapt to the rising rates of cesarean sections and IVF treatment to address the growing incidence of PAS.
The story of Amisha Adhia serves as a stark reminder of the vulnerabilities within the maternity care system. Her courage in sharing her experience has sparked a vital conversation about the need for improved diagnostic practices and specialized care for women at risk of placenta accreta. The ongoing inquiry into maternity care in England, coupled with the efforts of the Action for Accreta campaign, offers a crucial opportunity to implement meaningful changes and ensure that all women receive the safe and effective care they deserve. The RCOG is expected to publish updated guidelines on PAS management in late 2026, following the conclusion of the Amos inquiry.
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