Fertility and obstetric outcome after conservative management of placenta accreta

Abstract

Objective To determine the fertility and obstetric outcomes after conservative management of placenta accreta. Methods A retrospective observational cohort study of all identified cases of placenta accreta from 1993 to 2007 in 2 tertiary university hospitals in France. For patients treated conservatively, maternal and fetal morbidity, reproductive function, fertility, and subsequent pregnancies were recorded. Results During the study period, 46 patients were treated by conservative management; 6 patients underwent a secondary hysterectomy. Of the remaining 40 patients, 35 were followed up for a median of 65 months (range 18–156 months). Patients resumed their menstrual cycles after a median of 130 days (range 48–176 days). Menses were irregular in 11 patients (31%), but none had amenorrhea. Twelve of the 14 patients desiring another pregnancy achieved a total of 15 pregnancies; 2 patients had recurrent placenta accreta. Five spontaneous abortions and 1 termination of pregnancy occurred during the first trimester. The median term at delivery was 37 weeks (range, 35–40 weeks). Four patients delivered prematurely. Conclusion Conservative management of placenta accreta can preserve fertility, although the risk of recurrent placenta accreta appears to be high.