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Acta Obstet Gynecol Scand. 2013 Apr;92(4):445-50. doi: 10.1111/aogs.12075. Epub 2013 Jan 24.

Surgical management of placenta accreta: a 10-year experience.

Author information

1
Maternal Fetal Medicine Unit, Monash Medical Centre, Southern Health, Clayton, Victoria, Australia.

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 two-thirds 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.

PMID:
23311505
DOI:
10.1111/aogs.12075
[Indexed for MEDLINE]

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