Kim Kardashian revealed she suffers from the pregnancy complication placenta accreta, which may mean no more siblings for North West. But could a new surgery help?
Kim Kardashian West opened up recently about her battle with placenta accreta during her first pregnancy, and says she will likely have it again with her current one. Her revelation has brought attention to this severe pregnancy condition, in which the placenta attaches too deeply to the uterus and doesn't release after birth. It can be life-threatening, and often results in a hysterectomy. But now, a doctor from Argentina says he has perfected a surgical technique that might allow women like Kim to preserve their future fertility.
Saving the uterus
Previously, there were two ways for doctors to treat placenta accreta after birth: leaving it where it is and waiting for it to reabsorb, a process which takes months and risks infection; or removing the whole uterus, a major surgery that carries bleeding risks and means the patient can't have any more pregnancies. Now, "there is another treatment in which the invaded area is [cut out] with the entire placenta, and the uterus is repaired," José M. Palacios-Jaraquemada, M.D., Ph.D., an obstetrical surgeon and professor at the University of Buenos Aires in Argentina, tells Fit Pregnancy. "This procedure, named 'one-step conservative surgery,' it is an alternative which preserves the possibility of new pregnancies."
The surgery is very invasive, but it's a "conservative" approach in the sense that it will safeguard the patient's fertility. "The main benefit of the one-step conservative surgery is to preserve the uterus after solving all the problems caused by the placenta accreta, such as uterine damage," says Palacios-Jaraquemada, who specializes in treating the complication and has written a book on the subject. MRI or ultrasound is used beforehand to see exactly how deep the placenta has gone, and the surgery is performed right after the baby is born via planned C-section. "The complete dissection of invaded tissues allows us to identify the presence of a normal uterus below the invasion," Palacios-Jaraquemada says. "If there are three to four centimeters [of normal tissue] above the uterine cervix, the repair is technically feasible."
Previous studies have shown that other surgical approaches to remove the placenta were largely unsuccessful, but Palacios-Jaraquemada says more than 600 surgeries with his technique have been performed, and 177 of those women have gone on to have successful subsequent pregnancies so far. However, experts say more studies are needed before his surgery could be more widely implemented. "This procedure may have some merits for patients that do not have extensive invasion of the placenta in a large area of the uterus," Diane Ashton, M.D., M.P.H., an OBGYN and deputy director of The March of Dimes, tells Fit Pregnancy. "While this procedure may provide the possibility of preserving the uterus for some patients, it will require additional research to assess the risks and benefits before it could be considered a standard approach to placenta accreta. There is also the need to establish the criteria that will identify the patient for which this approach would be feasible and appropriate."
In addition, only highly skilled doctors could perform this surgery, Ashton says. "This is not a procedure that could be done at a local community hospital," she says. "This approach to a surgical procedure requires extensive expertise in 3D anatomical mapping to identify the exact areas of placental invasion. It also requires surgeons who are technically skilled in performing surgery requiring meticulous dissection and control of bleeding, which can be extensive. The hospital facility must also have significant resources to handle complicated surgical cases."
Although the procedure is not yet widely available, it holds promise for future sufferers of placenta accreta. Risk factors for the condition include previous uterine surgeries like C-section—in fact, the rise in the amount of C-sections being performed is likely why the number of cases of placenta accreta has increased in recent decades. Unfortunately there's not much you can do to reduce your risk. If your OB suspects you have it, Palacios-Jaraquemada advises talking through all options with her, and seeking a second opinion. Traveling to Argentina for his surgery might not be possible, but Palacios-Jaraquemada says that the technique is being learned by some doctors in Europe and America as well. Kardashian West, though, might have the resources to make the trip. "It would be a pleasure for me to help Ms. Kardashian, and also all women in need," he says.