PACCRETA: Clinical situations at high risk of Placenta ACCRETA/Percreta: impact of diagnostic methods and management on maternal morbidity

Abstract

Background. No population-based study has assessed the prevalence of placenta accreta, the predictive value of prenatal diagnostic examinations, the maternal morbidity associated with its management, or its psychological effects. Moreover, the technical resources necessary for the safest delivery of women at risk have not been clearly identified. Objectives. The primary objectives are to identify individual risk factors, as well as factors associated with types of management and with the healthcare facilities for postpartum hemorrhage. Secondary objectives are to (i) determine the prevalence of placenta accreta among women at risk; (ii) assess the predictive value of ultrasound and MRI for the diagnosis of placenta accreta in this population; (iii) evaluate psychological impact and physical complications; and (iv) report maternal physical complications during the year after delivery. Design. Population-based prospective observational study of pregnant women with a placenta inserted at a uterine scar. Setting. A total of 182 centers in eight French regions, with 270 000 deliveries annually. Methods. We expect to include 620 women at risk of placenta accreta in two years, of whom approximately 120 (20%) will have placenta accreta. Main outcome measures. The primary outcome measure is severe maternal hemorrhage; secondary outcome measures are maternal morbidity and deaths, predictive value of ultrasound and MRI, and psychological evaluations at 6 and 12 months. Conclusion. This study will be the first prospective population-based study to include women at risk of placenta accreta and to investigate incidence, prenatal detection, type of management, morbidity and maternal psychological consequences.

Retrospective multicenter study of leaving the placenta in situ for patients with placenta previa on a cesarean scar

“…Currently, there are no data available regarding optimal management when employing the leaving the placenta in situ approach . Therefore, as is already underway by the European Working Group on Abnormally Invasive Placenta, a prospective cohort study should be conducted to gain greater insight into factors related to severe adverse events when applying this approach.…”

Mode of anesthesia and clinical outcomes of patients undergoing Cesarean delivery for invasive placentation: a retrospective cohort study of 50 consecutive cases

“…As a result, the aggregate risk of maternal death may be as high as 7%. 22 Due to a high incidence of complications associated with the conservative surgical technique (e.g., postpartum fever, hospital readmission, delayed hemorrhage, delayed hysterectomy, and repeat embolization), the surgical technique has changed over the years to adopt an elective CHyst approach. Overall, 72% of our patients underwent CHyst, two-thirds under the RA technique and the remainder received GA. With this change, the use of uterotonics has similarly changed.…”

Optimal strategies for conservative management of placenta accreta: a review of the literature

“…Intriguingly, the recruitment of a prospective clinical trial titled, "Clinical Situations at High Risk of Placenta Accreta/Percreta: Impact of Diagnostic Methods and Management on Maternal Morbidity" has been active since 2013 in France. 100) Although we would expect that conservative management benefits both women who desire fertility preservation and those with placenta percreta, we need to wait for the results. Further studies are warranted to clarify the optimal strategies for the management of placenta accreta.…”