Objective To determine which interventions for managing placenta accreta were associated with reduced maternal morbidity.Design Retrospective cohort study.Setting Two tertiary care teaching hospitals in Utah.Population All identified cases of placenta accreta from 1996 to 2008.Methods Cases of placenta accreta were identified using standard ICD-9 codes for placenta accreta, placenta praevia, and caesarean hysterectomy. Medical records were then abstracted for maternal medical history, hospital course, and maternal and neonatal outcomes. Maternal and neonatal complications were compared according to antenatal suspicion of accreta, indications for delivery, preoperative preparation, attempts at placental removal before hysterectomy, and hypogastric artery ligation.Main outcome measures Early morbidity (prolonged maternal intensive care unit admission, large volume of blood transfusion, coagulopathy, ureteral injury, or early re-operation) and late morbidity (intra-abdominal infection, hospital re-admission, or need for delayed re-operation).Results Seventy-six cases of placenta accreta were identified. When accreta was suspected, scheduled caesarean hysterectomy without attempting placental removal was associated with a significantly reduced rate of early morbidity compared with cases in which placental removal was attempted (67 versus 36%, P = 0.038). Women with preoperative bilateral ureteric stents had a lower incidence of early morbidity compared with women without stents (18 versus 55%, P = 0.018). Hypogastric artery ligation did not reduce maternal morbidity.Conclusions Scheduled caesarean hysterectomy with preoperative ureteric stent placement and avoiding attempted placental removal are associated with reduced maternal morbidity in women with suspected placenta accreta.

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Background— Peripartum (PP) cardiomyopathy (CM) is a rare condition of unknown etiology that occurs in late pregnancy or early postpartum. Initial evidence suggests that genetic factors may influence PPCM. This study evaluated and replicated genome-wide association of single nucleotide polymorphisms with PPCM. Methods and Results— Genome-wide single nucleotide polymorphisms in women with verified PPCM diagnosis (n=41) were compared separately with local control subjects (n=49 postmenopausal age-discordant women with parity ≥1 and no heart failure) and iControls (n=654 women ages 30 to 84 years with unknown phenotypes). A replication study of independent population samples used new cases (PPCM2, n=30) compared with new age-discordant control subjects (local2, n=124) and with younger control subjects (n=89) and obstetric control subjects (n=90). A third case set of pregnancy-associated CM cases not meeting strict PPCM definitions (n=29) was also studied. In the genome-wide association study, 1 single nucleotide polymorphism (rs258415) met genome-wide significance for PPCM versus local control subjects ( P =2.06×10 −8 ; odds ratio [OR], 5.96). This was verified versus iControls ( P =7.92×10 −19 ; OR, 8.52). In the replication study for PPCM2 cases, rs258415 (ORs are per C allele) replicated at P =0.009 versus local2 control subjects (OR, 2.26). This replication was verified for PPCM2 versus younger control subjects ( P =0.029; OR, 2.15) and versus obstetric control subjects ( P =0.013; OR, 2.44). In pregnancy-associated cardiomyopathy cases, rs258415 had a similar effect versus local2 control subjects ( P =0.06; OR, 1.79), younger control subjects ( P =0.14; OR, 1.65), and obstetric control subjects ( P =0.038; OR, 1.99). Conclusions— Genome-wide association with PPCM was discovered and replicated for rs258415 at chromosome 12p11.22 near PTHLH . This study indicates a role of genetic factors in PPCM and provides a new locus for further pathophysiological and clinical investigation.