Management of placenta accreta in an Australian tertiary referral centre: a ten-year experience

Abstract

To report a ten-year experience in management of a highly morbid obstetrical condition in placenta accreta (PA) at a tertiary referral centre, uniquely equipped with an integrated Interventional Radiology theatre, with a primary aim to guide best practice. Retrospective analysis of all histologically proven PA cases at a tertiary centre in Australia between January 2004 and December 2013. Medical records were reviewed for obstetrics history, operative details, post-operative management and neonatal outcome. Sixteen cases of PA were identified during the tinie period; 75% had identifiable risk factors for PA and 87.5% of patients were diagnosed antenatally. Mean gestational age at time of delivery was 34 ±3.4 weeks. Ten cases were performed electively, while the remaining underwent emergency caesarean section. One patient was managed conservatively with placenta left insitu; time to complete resolution of placenta was 71 days. Among patients who underwent hysterectomy (15/16), the proportion of total (n=8) vs. subtotal (n=7) hysterectomy was similar. Average operating time was 123 ± 45.9 minutes. Compared to emergency cases, patients who underwent elective surgery had significantly lower blood loss (2.2 vs. 3.1 L, p < 0.05). Common iliac artery balloons were deployed in eight cases, with a non-statistically significant reduction in intraoperative blood loss (2 vs. 3.2 L, p < 0.05). Fifty percent of patients required ICU admission. Neonatal survival at six months was 93.75% (15/16). The present report demonstrates the importance of timely diagnosis and comprehensive preparation in the surgical management of patients with placenta accreta. The availability of relevant services in the peri-operative phase, including: obstetricians, interventional radiology facility and personnel, intensive care, and neonatology teams, are crucial in achieving optimal outcome for the patient and neonate. In line with reports in the literature, the authors advocate a team-based multidisciplinary approach in a tertiary-level centre for management of this high-risk condition.