Surgical management of placenta accreta: a 10-year experience

  • Grace Tan S
  • Jobling T
  • Wallace E
 et al. 
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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.

Author-supplied keywords

  • Adult
  • Australia
  • Blood Loss, Surgical/prevention & control/*statist
  • Female
  • Humans
  • Length of Stay/statistics & numerical data
  • Placenta Accreta/epidemiology/*surgery/ultrasonogr
  • Postoperative Complications/epidemiology/preventio
  • Postpartum Hemorrhage/epidemiology/*surgery/ultras
  • Pregnancy
  • Pregnancy Outcome/*epidemiology
  • Prenatal Care/utilization
  • Retrospective Studies
  • Treatment Outcome
  • Ultrasonography, Prenatal
  • Uterus/blood supply
  • Young Adult

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Authors

  • S E Grace Tan

  • T W Jobling

  • E M Wallace

  • L J McNeilage

  • T Manolitsas

  • R J Hodges

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