Placenta Previa with Focal Accretion

Abstract

Placenta previa accreta is a rare complication of pregnancy. Eight women with placenta previa with focal accretion (PPFA) were delivered in the authors' medical center between 1968 and 1977. The management and the maternal and perinatal outcomes are described in this report. The women with PPFA did not differ from those with placenta previa per se with respect to age, parity, or obstetrical history (Table 1). In all eight cases, the diagnosis of placenta previa was established by a history of bleeding (eight), radioiodinated serum albumin tests (six), or ultrasonography (two). All were managed expectantly, four from the second trimester and four starting from the third trimester. The mean blood loss per patient during pregnancy, as determined by the average blood transfusion rate, was similar in patients with PPFA and those with placenta previa per se, namely 0.7 units per patient. Five of the eight women with PPFA were delivered by low-segment cesarean section, two were delivered vaginally, and one had a breech extraction. The postpartum course was uneventful in four patients, all after cesarean section. Four women had postpartum hemorrhage (over 500 ml), two after vaginal delivery, one after breech extraction, and one after cesarean section. The latter patient developed hypovolemic shock and disseminated intravascular coagulation after cesarean section (despite administration of oxytocics and blood transfusions), and a hysterectomy had to be performed. The mean gestational age was 36 weeks (from the last menstrual period), with a mean birth weight of 2430 g. The perinatal mortality rate was 12.5 per cent, as compared with 11.2 per cent in the group with placenta previa per se. Two women subsequently delivered three times and twice, respectively, after the pregnancy complicated by PPFA. TABLE 1 Presentation of women with placenta previa per se and placenta previa with focal accretion Placenta previa Placenta previa with focal accretion (W = 145) (N = 8) Age (yr) 14–42 (30)* 25–39 (32) Parity 0–9 (3) 1–3 (2) Gravidity 1–9 (5) 3–9 (6) Previous cesarean 15 2 section Present pregnancy Postpartum 2 4 hemorrhage Hysterectomy 1 1 Disseminated 1 1 intravascular cqagulopathy * Figures in parentheses represent mean values.