Abstracts
Conservative management of placenta percreta

https://doi.org/10.1016/j.ajog.2004.10.236Get rights and content

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Objective

Disorders of placental adherence are increasing in frequency. The objective of this study was to demonstrate a reduction in maternal morbidity when a prenatal diagnosis was available and a comprehensive perinatal protocol was implemented.

Study design

Between January 2002 and June 2004, diagnosis of placenta percreta was made using ultrasound with color Doppler and/or MRI. A protocol was instituted consisting of (1) planned cesarean section at 36 weeks or earlier, (2) intraoperative assessment of the extent of placental invasion and vascularity, (3) placental mapping with ultrasound, and (4) cystoscopy. The feasibility of dissection at the time of surgery lead to a decision between a cesarean-hysterectomy with a “modified radical” approach

Results

Six out of 8 patients were diagnosed prenatally, of which two underwent cesarean-hysterectomy and four had a delayed hysterectomy within 2 to 4 weeks. Total estimated blood loss in this group ranged from 1300 to 2000 mL requiring transfusion of 0 to 5 units. One patient in the delayed group required early hysterectomy due to a suspected infection. No other complications were found in these patients. Pathology reports confirmed a placenta percreta in these 4 patients and a placenta increta in

Conclusion

Prenatal diagnosis of placental invasion allows implementation of a conservative management protocol for placenta percreta which significantly decreases maternal morbidity and mortality. Careful intraoperative assessment accurately identifies candidates for a delayed hysterectomy.

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