Surgical management of placenta accreta: a 10‐year experience

Abstract

Objective. To examine maternal morbidity in primary surgical management of placenta accreta. Design. Retrospective case series. Setting. Quaternary perinatal referral center in Melbourne, Australia. Population. Clinically suspected and histologically confirmed cases of placenta accreta, increta and percreta. Methods. Women were identified from our hospital database coded for placenta accreta, increta, percreta and peripartum hysterectomy. Relevant details were sought from medical records. Main outcome measures. Predefined maternal morbidities: blood loss, transfusion requirements, surgical complications, reoperation rate, duration in hospital. Predefined neonatal outcomes: gestational age at birth, birth-weight, admission to intensive (NICU) or special care nurseries (SCN), respiratory distress syndrome. Results. Between 1999 and 2009, 33 women were diagnosised with invasive placentation. A total of 27 were confirmed histologically after hysterectomy: 12 accreta, one increta, and 14 percreta. Median blood loss was 2 L. There was a 1.8-L reduction in mean blood loss with elective vs. emergency hysterectomy (p = 0.04). Nearly twothirds of women required four or more units of packed red-blood-cells. Half of the women suffered from surgical complications, mostly from bladder injury. The risk of returning to theater for further surgery was 20%. Women with placenta percreta were more likely to require additional blood products (p = 0.03), sustain renal tract injury (p = 0.003) and require intensive care admission (p = 0.002). Conclusions. A primary surgical approach to management of placenta accreta is associated with significant maternal morbidity, even when managed in a dedicated quaternary perinatal referral center.Abbreviations: NICU, neonatal intensive care unit; SCN, special care nursery.

A Single Center Experience on the Management of Placental Invasion Abnormalities

“…Eighty-six percent of patients required blood transfusion and nearly two thirds of these women were transfused at least four units of packed red blood cell. These results are consistent with previously published reports regarding surgical management of placental invasion abnormalities [3,15]. However, reduction of emergency surgery by antenatal diagnosis can play important role to decrease potential morbidity and mortality rates [11,16,17].…”

Failed conservative management in a case of placenta percreta lead to total hysterectomy for haemostasis and bladder injury

“…This condition is defined as RPOC, meanwhile, leaving placenta in place as a conservative treatment of placenta accreta is a voluntary therapeutic approach. Both conditions are causes of both primary and secondary postpartum hemorrhage [1]. One of the most important risk factors for RPOC is placenta accreta.…”

“…According to the latest epidemiological studies, the number of cases of placenta accreta increased because of higher caesarean rates due to a greater number of accepted indications for caesarean sections, including maternal request [1]. The reported incidence of placenta accreta was 1 in every 533 pregnancies in one report and 2% in another report [1,2]. Strong risk factors for abnormal placentation include previous caesarean scars and placenta previa.…”

“…Ideally, the diagnosis should be antenatal evaluated in high-risk pregnancies suspected following ultrasound [1]. This could allow for pre-delivery planning to reduce maternal morbidity and mortality.…”

“…Unfortunately, most cases are identified only at the time of delivery when forcible attempts at manual removal of the placenta are unsuccessful [3]. Severe postpartum hemorrhage may result and may lead to complications such as massive transfusion of blood products; disseminated intravascular coagulation (DIC); acute renal failure; infectious morbidities; acute respiratory distress syndrome (ARDS); loss of fertility [1]. Mortality rate may reach 7% [4].…”