The management and outcomes of placenta accreta, increta, and percreta in the UK: a population‐based descriptive study

Abstract

Objective To describe the management and outcomes of placenta accreta, increta, and percreta in the UK. Design A population‐based descriptive study using the UK Obstetric Surveillance System (UKOSS). Setting All 221 UK hospitals with obstetrician‐led maternity units. Population All women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011. Methods Prospective case identification through the monthly mailing of UKOSS. Main outcome measures Median estimated blood loss, transfusion requirements. Results A cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100 ml, P = 0.008) and a reduced need for blood transfusion (59 versus 94%, P = 0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P = 0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P < 0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700 ml, P = 0.001) and a reduced need for blood transfusion (57 versus 86%, P < 0.001). Conclusions Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

“…This represents only a summary of key points; many more specific messages for care are reported in the publications about individual conditions and these should be referred to for further detail. 54,71,72,181,220,221 The incidence of the specific morbidities most commonly leading to maternal death in the UK We examined the incidence of AFE, severe maternal sepsis, uterine rupture, HELLP syndrome and placenta accreta/increta/percreta. Because the studies conducted were national cohort or case-control studies, we were able to estimate incidence of each condition with a relatively high degree of precision.…”

New Multidisciplinary Approach of Conservative Surgical Management of Placenta Percreta Antenatally Diagnosed

“…In the 2 cases of APA suspected prenatally, no attempt of preventive measures of postpartum hemorrhage were made and these two cases were complicated by severe bleeding and ended with a hysterectomy. The radical treatment of cesarean-hysterectomy should be performed according to international recommendations [10,14] without attempt to remove placenta. It leaves no possibility of subsequent fertility in patients.…”

“…In case of strong diagnostic suspicion, the recommended standard care is a planned cesarean-hysterectomy, without attempted to remove placenta, in a tertiary care center [10].…”

Peripartum Hysterectomy

“…Of concern however is the limited experience of performing emergency hysterectomy among some obstetricians. Emergency peripartum hysterectomy being performed by an experienced surgeon is reported to significantly reduce maternal morbidity in general, operating time, number of units of blood transfusion and hospital stay in particular [60,61].…”