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J Gynecol Obstet Biol Reprod (Paris). 2007 Nov;36(7):680-7. Epub 2007 Jun 15.

[Conservative versus radical management in cases of placenta accreta: a historical study].

[Article in French]

Author information

  • 1Service de gynécologie-obstétrique, CHI de Créteil, université Paris-XII-Henri-Mondor, France. gkayem@gmail.com

Abstract

OBJECTIVE:

To compare the impact of conservative and radical strategies for placenta accreta on maternal morbidity and mortality.

METHODS:

We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta admitted to our tertiary center from January 1993 through October 2005. Two consecutive periods, A and B, were compared: during period A (january 1993 to June 1997), our written protocol called for the systematic manual removal of the placenta, to leave the uterine cavity empty. In period B (July 1997 to October 2005), we changed our policy and attempted to treat patients with a placenta accreta conservatively. The following outcomes over the two periods were compared: need for blood product transfusion, hysterectomy, intensive care admission, duration of stay in intensive care unit, sepsis and disseminated intravascular coagulation.

RESULTS:

Fifty-one cases of placenta accreta were observed among 40281 deliveries (1.3/1000). Period B saw a reduction in the hysterectomy rate (11/13 versus 10/38; P < 0.01), the mean red blood cells transfused (3230+/-2170 versus 1081+/-1370 ml; P < 0.01) and disseminated intravascular coagulation (5/13 versus 1/38; P < 0.01) compared with period A. Seven cases of maternal infection were recorded during period B and none during period A (p = 0.22).

CONCLUSION:

Conservative management of placenta accreta appears to be a safe alternative to radical management.

PMID:
17573204
[PubMed - indexed for MEDLINE]
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