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Am J Perinatol 2024; 41(S 01): e420-e429
DOI: 10.1055/a-1885-1942
Original Article

Leaving the Placenta In Situ in Placenta Accreta Spectrum Disorders: A Single-Center Case Series

Beth L. Pineles
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Texas
,
Jennie Coselli
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Texas
,
Tala Ghorayeb
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Texas
,
Michal Fishel Bartal
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Texas
,
Rodrick C. Zvavanjanja
2   Department of Diagnostic and Interventional Radiology, McGovern Medical School at The University of Texas Health Science Center at Houston, Texas
,
Sean C. Blackwell
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Texas
,
Ramesha Papanna
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Texas
,
Baha M. Sibai
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Texas
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Abstract

Objective The most common treatment for placenta accreta spectrum (PAS) disorders is planned primary cesarean hysterectomy. However, other management strategies may improve outcomes and/or allow fertility preservation. The objective of this study was to describe the course and outcomes of patients with PAS managed by leaving the placenta in situ.

Study Design This is a series of 11 patients with PAS managed by leaving the placenta in situ at a single academic center in the United States from 2015 to 2022. The approach described involves delivery of the fetus via cesarean, no attempt at placental removal, closure of the hysterotomy, prophylactic intravenous antibiotics for up to 1 week, and close outpatient follow-up until the uterus is empty.

Results The uterus was successfully preserved in six (55%), minimally invasive hysterectomy was performed in four (36%), and abdominal hysterectomy was performed in 1 (9%). During cesarean delivery, the median estimated blood loss was 650mL (range: 200–1,000mL). The majority of patients had no vaginal discharge for several weeks after delivery, followed by brown or bloody discharge, and intermittent mild-to-moderate cramping. The median time to resolution of PAS was 18 weeks in patients with successful uterine preservation (range: 5–25 weeks). Indications for hysterectomy included hemorrhage (n=1), coagulopathy (n=1), endomyometritis (n=2), and pain (n=1), and these occurred at a median of 5 weeks postpartum (range: 1–25 weeks). Four patients had subsequent pregnancies of whom three were live births at or near term and one was a spontaneous abortion at 19 weeks.

Conclusion Leaving the placenta in situ may be an appropriate management strategy for some carefully selected and counseled patients with PAS.

Key Points

  • Overall, 55% had uterine preservation (6/11).

  • Minimally invasive approach in 80% of hysterectomies (4/5).

  • Of patients, 67% with uterine preservation had subsequent pregnancies (4/6).

Keywords

accreta - increta - percreta - morbidly adherent placenta - conservative management - leaving the placenta in situ

Supplementary Material



Publication History

Received: 07 June 2022

Accepted: 21 June 2022

Accepted Manuscript online:
25 June 2022

Article published online:
12 September 2022

© 2022. Thieme. All rights reserved.

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