Campaign urges NHS to improve diagnosis of a potentially life-threatening childbirth condition
But here's where it gets controversial: after five hospitals failed to recognize a rare but deadly complication of childbirth, Amisha Adhia is launching a campaign to push the NHS to do more to diagnose placenta accreta spectrum (PAS) and save lives.
Pregnant people who have already had a cesarean delivery or undergone IVF treatment face a higher risk of PAS. If the condition isn’t identified before labor begins, there is a real danger of needing an emergency hysterectomy or dying from massive bleeding.
The NHS estimates that PAS affects between 1 in 300 and 1 in 2,000 women. Medical professionals warn that the number of at-risk pregnancies could be rising because more babies in England are being born by C-section (about 45%) than vaginal birth (roughly 44%), a shift that may expand the group of people susceptible to PAS.
“Placenta accreta can trigger catastrophic bleeding in minutes if we don’t anticipate it,” says Adhia, who started the Action for Accreta campaign with her husband, Nik. She argues that too few maternity specialists in the NHS correctly diagnose PAS, leaving women and their babies exposed to severe danger.
PAS occurs when the placenta grows too deeply into the uterine wall, making it difficult to detach during birth and potentially obstructing the cervix. This deep invasion can lead to substantial bleeding during delivery.
At five London hospitals, Adhia’s doctors told her she did not have PAS. It was only after Dr. Chineze Otigbah, a consultant obstetrician, reviewed her case that the diagnosis was confirmed. Because of the timely intervention, Adhia, now 36, received appropriate care when giving birth to her daughter Ishaani at Queen’s Hospital in Romford, northeast London, last September.
“I’m alive today because Dr. Otigbah recognized the danger and acted,” Adhia recalls. She says she was repeatedly assured she was at minimal risk due to a high placenta position, yet the condition was present and deeply invasive. “I was reassured into danger. I carried a condition that could have killed us both. I felt unheard. I thought I was going to die.”
Adhia says she lost almost a liter of blood during Ishaani’s cesarean birth, though her outcome was better than many PAS cases. Her feelings of being dismissed by the initial five hospitals—who she says downplayed her concerns—motivated her and Nik to raise awareness about PAS.
Roughly 40 more pregnant people or new mothers who experienced complications from undiagnosed PAS have contacted the couple after seeing their posts online.
There are no official figures on how often PAS develops or leads to complications because the NHS does not systematically record this data. Even the annual MBBRACE-UK maternal health report lacks PAS specifics. Some studies from the US and Israel estimate a prevalence as high as about 1 in 111 pregnancies.
Eight maternal and baby health groups have endorsed the campaign, including Birthrights and the Birth Trauma Association. Baby charities Tommy’s and Sands also welcomed the effort, noting it highlights gaps in awareness, surveillance, and learning about serious pregnancy complications.
Current guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) acknowledges that PAS and placenta praevia—another major cause of heavy bleeding—are associated with increased maternal and neonatal morbidity and mortality. RCOG notes that rates are rising and are likely to continue increasing due to more cesareans, higher maternal age, and greater use of assisted reproductive technologies. The organization is updating its guidance, with publication expected later this year.
The Adhias recently provided testimony to Valerie Amos’s inquiry into maternity care in England, prompted by a government-ordered review. They urged Amos to include recommendations to improve PAS identification within the NHS.
Obstetric experts emphasize that the main risk factors for PAS—cesarean sections and IVF—have grown, yet some NHS hospitals still lack PAS specialists, which can cause subtle warning signs to be missed.
The Adhias want the RCOG to explicitly address diagnosing and managing atypical PAS in its updated guidelines, reflecting Amisha’s experience.
An RCOG spokesperson stressed that placenta accreta spectrum is rare but can cause life-threatening bleeding if not detected early. They noted the importance of early identification through pregnancy scans and follow-up imaging to enable careful planning and access to specialist teams, which improves outcomes for both mother and baby. The updated guidelines are anticipated to be released later this year.
NHS England did not respond directly to the concerns raised. Professor Donald Peebles, national clinical director for maternity, underscored that PAS is rare but can lead to dangerous bleeding when it occurs, which is why early risk assessment is crucial. He pointed out that maternity teams monitor for warning signs, prioritizing women with prior cesareans for specialist referrals when necessary.
Would you support stronger NHS protocols to routinely screen for PAS in pregnancies with known risk factors, even if it means more women are referred to specialist centers? If you have experiences or opinions on PAS awareness and care, share them in the comments.
