Individual decisions in placenta increta and percreta: a case series

Abstract

Objective: Placenta increta or percreta is an uncommon pathology, sometimes associated with high maternal morbidity. Its prevalence increases proportionally to the number of cesarean sections. This study analyzed the changes of our management strategy to devise treatment guidelines for this uncommon disorder. Materials and methodology: Between 2005 and 2011, 10 cases of placenta increta or percreta were managed at our university hospital maternity department. Results: Among the 10 cases, seven were diagnosed prenatally. Two patients were diagnosed early, at 14 and 17 weeks of gestational age, and their pregnancies were terminated. Five had hysterectomies during the intrapartum period, and despite attempted conservative treatment for the two others, hysterectomy proved necessary 2 months postpartum because of intrauterine infections. Seven of the 10 women had hysterectomies. Conclusion: Prenatal diagnosis of placenta increta or percreta is essential to plan the delivery in a competent tertiary care center. The decision to perform a cesarean hysterectomy or leave the placenta in situ for spontaneous delivery is based on the extent of infi ltration, the patient ' s hemodynamic status, and her desire to remain fertile. The high-risk of infection and severe hemorrhage must not be overlooked should conservative treatment be chosen. This situation requires prolonged close monitoring.

Management of patients with placenta accreta in association with fever following vaginal delivery

“…[15] Based on our experiences, we suggest avoiding forced manual placenta removal if the placenta has infiltrated the perimetrium and surrounding tissues. Ultrasound and/or MRI should be performed to confirm placenta implantation, and placenta removal should be conducted by experienced obstetrician under ultrasound guidance.…”

Placenta Praevia and Placenta Accreta: Diagnosis and Management

“…16,17,142,143 Determining the depth and lateral extension of placental invasion is helpful for planning the individual care of women diagnosed with placenta accreta spectrum. 16,17,144 No ultrasound sign or a combination of ultrasound signs have so far been found to be specific to the depth of placenta accreta spectrum to provide an accurate differential diagnosis between adherent and invasive accreta placentation. 16 This may be due to the wide heterogeneity in terminology used to describe the grades of placenta accreta spectrum, differences in study design with most studies not reporting detailed data on clinical diagnosis at birth and/or on histopathology examination, and many studies having included cases of placental retention in their cohort with no evidence of abnormal villous adherence or invasion.…”

FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology,

“…Prenatal evaluation of the depth of placental invasion is essential for planning individual management of women diagnosed with PAS disorders. 52 Despite the fact that around 90% of women diagnosed prenatally with placenta previa accreta in the last 30 years have undergone an elective or emergent cesarean hysterectomy, 44 containing PAS disorders. Previous studies have indicated that PAS disorders can be focal or partial and heterogeneous, mixing adherent and invasive accreta villous tissue.…”