Improving the management of placenta praevia accreta

Abstract

Objectives The aims of this study were to assess the incidence of placenta praevia accreta, to identify risk factors for this complication and to analyse sonographic findings and the outcomes of interventions. This should improve antenatal diagnosis and facilitate the introduction of a new protocol for conservative management of this condition. Materials and methods This is a retrospective and descriptive study, over a period of 30 months, of women who underwent a caesarean section (CS) owing to placenta praevia accreta within the Obstetrics and Gynaecology Department at Dubai Hospital, United Arab Emirates. During this time, all files were reviewed and parameters collected, including patients' profile, risk factors, interventions, complications, blood loss, blood transfusion and length of hospitalization. Results. There were 11 cases of placenta praevia accreta (1 in 909 births). Two major risk factors were identified: the presence of a pre-existing uterine scar and previous occurrence of placenta praevia. Ultrasound findings were of limited use in reaching a diagnosis, resulting in 7 of these 11 patients requiring emergency intrapartum hysterectomy. Two had bladder injuries with blood loss of 2.9 l, and most of the patients required massive transfusion. The mean hospital stay was 7.1 days. The results were compared with those reported in the literature. Conclusions Previous placenta praevia and previous CS delivery are associated with placenta accreta, and result in an increased risk of morbidity and mortality. A key priority must be the introduction of a new protocol to include leaving the placenta in situ, particularly in women who wish to become pregnant again in the future.