Optimal management strategies for placenta accreta

Abstract

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.

Morbidly Adherent Placenta: Its Management and Maternal and Perinatal Outcome

“…Maternal morbidity had been reported to occur in up to 60 % and mortality in up to 7 % of women with morbidly adherent placenta [8,9]. Considering this risk of substantial morbidity (including coagulopathy, severe haemorrhage, infection, sepsis, ureteral injury, need for blood transfusion/hysterectomy) and mortality, uterus-preserving treatment may have a role in carefully selected patients who desire future fertility [22].…”

“…It is the most frequent indication for peripartum hysterectomy [5][6][7]. It addition, the incidence of perinatal complications is also increased due to preterm birth and small for gestational age foetuses [8,9].…”

Intraoperative Surgical Treatment of Undiagnosed Placenta Percreta

“…Conservative interventions are recommended before radical procedure in order to minimize surgical complications and preserve fertility. The conservative options for peripartum hysterectomy included uterotonic drugs, external compression with uterine sutures (B-Lynch, Hayman, Cho), intrauterine packing (Bakri balloon), Triple-P procedure, and selective devascularization by ligation or embolization of the uterine artery [19][20][21]. Identifying the extent of infiltration by the placenta and performing preoperative placement of bilateral iliac artery or aorta balloon catheters to be inflated after delivery can considerably reduce the bleeding.…”

Morbidly Adherent Placenta in Mid Trimester Abortion - A Case Report

“…A conservative approach was first described by Arulkumarran and colleagues is 1986 by using systemic MTx 17 .Severe intrauterine infection and life threatening haemorrhage can occur requiring emergency hysterectomy, thus patients should be carefully monitored and extensively counseled regarding risks. 18 MTx has an important role is conservative management of placenta percreta with bladder invasion and it has been used in any patients. 19 MTx a folate antagonist, and primarily against rapidly dividing cells and therefore is effective against proliferating trophoblast.…”