Clinical aspects and conservative management of placenta accreta

Abstract

Placenta accreta is a rare complication of human placentation with fertility and life‐threatening sequelae. Traditional management has centred upon hysterectomy and its prompt undertaking has been well documented in saving lives. While in many situations hysterectomy will remain appropriate, there are other management options available involving conservative approaches. This article reviews the diagnosis and demographics of this potentially frightening pathology and highlights the important aspects of conservative management if hysterectomy is to be avoided.

Alternative management in a case of placenta accreta with previous caesarean

“…3 This does not guarantee success. 1 Leaving the placenta in situ with planned interval removal, if nothing else, may facilitate a more planned approach to potentially high-risk surgery. Though complications of leaving the placenta in situ have also been reported.…”

“…Though complications of leaving the placenta in situ have also been reported. 1 It is possible to excise the placental site. 13 If the area of accreta is focal and the majority of the placenta has been removed, then a wedge resection of the area can be performed.…”

“…13 If the area of accreta is focal and the majority of the placenta has been removed, then a wedge resection of the area can be performed. 1 Bilateral uterine artery embolisation, argon beam coagulation of the placental bed and Pelvic artery ligation (anterior division of internal iliac or uterine artery) have been mentioned with varying success. [14][15][16] If the placenta has been left in situ, the woman requires follow-up to ensure the resolution of placental tissue.…”

“…Over the last 50 years, the incidence of placenta accreta is estimated to have increased ten-fold. 1 …”

An undiagnosed case of placenta percreta presenting as a massive hemoperitoneum in obstetric emergency

“…Evidence suggests that bilateral uterine artery embolization is less likely to be successful in cases of abnormal placentations. 12 Planning for delivery should involve a team including a maternal fetal specialist, an anesthesiologist, a urologist, a hematologist, an interventional radiologist, and a pelvic surgeon to optimize patient outcome. Delivery should be done in a specialized tertiary center with adequate resources, including those for massive transfusion anticipating need for hysterectomy.…”