Managing placenta accreta

OBG Management PubMed

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August 2002 · Vol. 14, No. 8

In the past, surgery was the only option for women with abnormally adherent placentae, but conservative medical management may be an alternative for select patients. Here, the authors review recent trends and describe medical and surgical options.

ANDREW F. HUNDLEY, MD

AVIVA LEE-PARRITZ, MD

Dr. Hundley is chief resident and Dr. Lee-Parritz is medical director, labor and delivery, in the department of OBG at Brigham and Women’s Hospital in Boston.

KEY POINTS

Placenta accreta occurs in approximately 1 in 2,500 deliveries.
Risk factors include placenta previa, Asherman’s syndrome, the existence of a prior hysterotomy scar, and advanced maternal age or parity.
Almost 50% of all cases of placenta accreta are diagnosed antepartum.
MRI combined with ultrasound has a sensitivity of 100% in identifying placenta accreta.
Medical management should be considered only when the patient wishes to preserve her fertility and when no active uterine bleeding is present.
Gravid hysterectomy has been associated with a mortality rate of 7.4%, with a 90% incidence of transfusion, a 28% incidence of postoperative infection, and a 5% incidence of ureteral injuries or fistula formation.

Placenta accreta is an uncommon but potentially lethal complication of pregnancy. It occurs when the placenta is abnormally adherent to the uterine myometrium as a result of partial or complete absence of the decidua basalis and Nitabuch’s layer. The depth of invasion determines the histologic classification: Placenta accreta indicates direct attachment of the placenta to the myometrium; placenta increta describes placental invasion into the myometrium; and placenta percreta indicates full-thickness compromise of the myometrial layer. Deeper invasion is associated with more serious complications.

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