Retrospective analysis of placenta accreta: management strategies – evaluation of 41 cases

Abstract

Objective: The aim of the study was to evaluate maternal characteristics, surgical treatment options, and morbidity of patients with placenta accreta. Methods: We retrospectively reviewed the medical records of placenta accreta patients who were diagnosed and hospitalized between 2006 and 2010 at the Obstetrics and Gynecology Clinics of the Dicle University Hospital (Center A) and Maternity Hospital (Center B) in Diyarbakir, Turkey. The data were retrieved from medical charts of both hospitals. Maternal demographic features, clinical outcomes, type of surgical intervention, and complicationswere evaluated. Results: The incidence of placenta accreta was 1/426 deliveries in Center A and 1/7573 deliveries in Center B over a 5-year period. Thirty-nine (95.1%) patients had placenta previa, and 32 (78.0%) patients had at least one previous cesarean delivery. Hysterectomy was performed in 28 (68.3%) of 41 women with placenta accreta and uterine preservation was achieved in 13 (31.7%) of them. One (2.4%) maternal death occurred. Estimated blood loss was >2 liters and all patients required blood products transfusion. Conclusion: Placenta accreta is highly associated with the existence of placenta previa, especially in cases with previous cesarean delivery. When placenta accreta is diagnosed or suspected, the patient should be referred to a tertiary center for optimum care, where the obstetrical team should include experienced pelvic surgeons who are capable of performing emergent hysterectomy, internal iliac artery ligation, and uterine devascularization procedures.