American Journal of Obstetrics & Gynecology
Volume 202, Issue 1 , Pages 38.e1-38.e9, January 2010

Surgical management of placenta accreta: a cohort series and suggested approach

Presented at the combined XXIst Asian and Oceanic Congress of Obstetrics and Gynecology and Annual Scientific Meeting of the Royal Australian and New Zealand College of Obstetricians and Gynecologists, Auckland, New Zealand, March 27-30, 2009.

  • Tobias Angstmann, MB BS

      Affiliations

    • Division of Women's, Children's, and Family Health, Royal North Shore Hospital, St. Leonards, NSW, Australia
    • ,
  • Gregory Gard, MB BS, BSc (Med)

      Affiliations

    • Division of Women's, Children's, and Family Health, Royal North Shore Hospital, St. Leonards, NSW, Australia
    • Northern Clinical School, University of Sydney, Sydney, NSW, Australia
    • ,
  • Tim Harrington, MB BS

      Affiliations

    • Department of Interventional Radiology, Royal North Shore Hospital, St. Leonards, NSW, Australia
    • ,
  • Elizabeth Ward, MD

      Affiliations

    • Department of Anesthesia, Royal North Shore Hospital, St. Leonards, NSW, Australia
    • Northern Clinical School, University of Sydney, Sydney, NSW, Australia
    • ,
  • Amanda Thomson, MB BS

      Affiliations

    • Department of Hematology, Royal North Shore Hospital, St. Leonards, NSW, Australia
    • ,
  • Warwick Giles, MB BS, PhD, CMFM

      Affiliations

    • Division of Women's, Children's, and Family Health, Royal North Shore Hospital, St. Leonards, NSW, Australia
    • Northern Clinical School, University of Sydney, Sydney, NSW, Australia

Received 25 March 2009; received in revised form 15 June 2009; accepted 20 August 2009. published online 18 November 2009.

Objective

The purpose of this study was to describe the use of a staged procedure that involved femoral artery catheterization, classic cesarean section delivery, and uterine and placental embolization before hysterectomy for placenta accreta.

Study Design

We conducted a cohort study of retrospective and prospective data from cases of histologically identified placenta accreta at a tertiary teaching hospital with access to interventional radiology.

Results

Twenty-six cases of placenta accreta were identified histologically (7 accretas, 5 incretas, and 14 percretas); 8 cases were successful staged embolization procedures. These cases had significant reductions in blood loss (553 vs 4517 mL; P = .0001), need for transfusion (2 vs 16; P = .001), and units of blood transfused (0.5 vs 7.9; P = .0013). The total operation time was no different between the 2 groups, but there was a longer length of anesthesia (2.7 vs 6.6 hours; P = .0001). There were nonsignificant reductions in admission to the intensive care unit and length of hospital stay.

Conclusion

We found that the successful use of a staged embolization hysterectomy procedure for placenta accreta is associated with decreased maternal morbidity.

Key words: cesarean section delivery, embolization, hemorrhage, hysterectomy, placenta accreta

 

 Reprints not available from the authors.

 Authorship and contribution to the article are limited to the 6 authors indicated. There was no outside funding or technical assistance with the production of this article.

 Cite this article as: Angstmann T, Gard G, Harrington T, et al. Surgical management of placenta accreta: a cohort series and suggested approach. Am J Obstet Gynecol 2010;202:38.e1-9.

PII: S0002-9378(09)00963-6

doi:10.1016/j.ajog.2009.08.037

American Journal of Obstetrics & Gynecology
Volume 202, Issue 1 , Pages 38.e1-38.e9, January 2010

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