Why This Pregnancy Might Be Kim Kardashian West’s Last

In a recent C Magazine interview, Kim Kardashian West revealed that she’s been dealing with a potentially life threatening condition called placenta accreta.

When interviewer Amanda de Cadenet remarked that she thought her current pregnancy had happened quickly, Kim revealed:

“It was over a year of trying, and I had so many complications. I had this condition called placenta accreta. There were a couple of little operations to fix all that, so that created a little hole in my uterus, which I think made it really tough to get pregnant again.”

She added that her physicians:

“…  think I’ll have placenta accreta again, so if the placenta grows a little bit deeper than it did last time, then they are prepared to have my uterus removed, which is a little scary for me. I think we’re just gonna go day by day, see how overwhelming it is, and see how the delivery goes.”

A short lesson about the placenta

The placenta (also known as afterbirth) is the organ that connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange through the mother’s blood supply.  It also helps fight against infection and produces hormones to support the pregnancy.

The placenta is connected to the fetus by the umbilical cord, which is about 22-24 inches in length. The umbilical cord contains two umbilical arteries and one umbilical vein.

The placenta is made of tissue from both the mother and the fetus, closely bound together. It has two different surfaces,  the maternal surface, coming off of the uterus, and the fetal surface, facing inward towards the fetus. The umbilical cord arises from the fetal surface.

Placenta_cartoon

The Fetal Surface of the Placenta

placentaThe fetal surface of the placenta is covered by a structure called the amnion, or amniotic membrane. The amniotic membrane secretes amniotic fluid, a fluid that is breathed in and out by the fetus and serves as a form of protection and cushion against the walls of the uterus.

Underlying the amnion is the chorion, a thicker membrane, which is continuous with the lining of the uterine wall. Emerging from the chorion are fingerlike projections called villi. Within these chorionic villi are a system of fetal capillaries (blood vessels). It is at this level (also known as the intervillous space) where the exchange of oxygen, carbon dioxide and nutrients occurs.

The Maternal Surface of the Placenta

The maternal surface of the placenta is composed of the decidua, what is known as the uterine lining during pregnancy.

Visible on the maternal surface are lobules, approximately 15 to 20 called cotyledons. They are divided by deep channels more commonly known as sulci. Each individual lobule is divided into smaller sections containing one villi. These villi are the same ones emerging from the chorion, containing fetal capillaries, which bathe in the intervillous space (it is important to note that fetal and maternal blood never mix).

After Birth

After the baby is delivered, the placenta is no longer needed and is expelled from the body. This is often referred to as the Third Stage of Labor (stage 1 is dilation of the cervix, stage 2 the delivery of the baby). The placenta is released from the uterine wall and the uterus contracts to expel it. The contraction of the uterus also helps to control bleeding after birth by squeezing down and compressing the blood vessels in the uterus.

What is placenta accreta?

Placenta accreta is a general term used to describe when part of the placenta invades and becomes inseparable from the wall of the uterus. When the chorionic villi invade only the myometrium (the muscular layer of the uterus), the term placenta increta is used. If the placenta invades deeper whereas  through the myometrium and serosa (occasionally into adjacent organs, such as the bladder) the term placenta percreta is used.

Placenta accreta may be diagnosed by ultrasound during the second or third trimester. It is usually asymptomatic, although vaginal bleeding in the third trimester is a possible presentation.

Abnormal placentationsm
Placenta accreta can becomes a problem during delivery when the placenta does not completely separate from the uterus. The uterus is not able to completely contact, and can cause massive blood loss by the mother. This is a potentially life-threatening situation, and is often treated by removal of the uterus to stem the blood loss. Patients diagnosed with placenta accreta prior to delivery are typically delivered by C-section.

Placenta accreta is thought to be related to abnormalities in the lining of the uterus, most commonly  due to scarring after a C-section or other surgery done on the uterus. Defects in the lining might allow the placenta to grow too deeply into the uterine wall. Placenta accreta can occur without a history of uterine surgery.

According the American Congress of Obstetricians and Gynecologists, the incidence of placenta accreta has been increasing and seems to parallel the increasing cesarean delivery rate. Researchers have reported the incidence of placenta accreta as 1 in 533 pregnancies for the period of 1982–2002. This contrasts sharply with previous reports, which ranged from 1 in 4,027 pregnancies in the 1970s, increasing to 1 in 2,510 pregnancies in the 1980s.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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