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283: Prenatal vs intraoperative diagnosis of placenta accreta: Effects on maternal outcomes in 100 consecutive cases

      Objective

      To evaluate the effects of prenatal diagnosis of placenta accreta (PA) on maternal outcomes including gestational age at delivery, EBL, transfusion requirements, length of hospital stay and operative complications.

      Study Design

      A retrospective chart review was performed consisting of all patients with pathologically confirmed PA cared for at the University of California San Diego from January 1990 to April 2008. Data collected included maternal demographics, antenatal diagnosis, operative findings and complications including EBL, transfusions (blood products given), operative time, and length of hospital stay. Analysis was performed using SPSS v 11.5.

      Results

      In the period from January 1990 to April 2008, 100 patients had a pathologically confirmed PA. The median maternal age was 33 years, and 85% of patients had at least one cesarean delivery. 65 patients were diagnosed prenatally (PND) while 35 went undiagnosed (PNU). PND was associated with a higher frequency of prior CS (95% vs 68%), lower frequency of posterior placentation (2% vs 24%) and more previas (81% vs 48%) than the PNU group (p<.01). Cesarean hysterectomy (C hyst) was planned and performed as scheduled in 63% of PND whereas 90% of the PNU required emergent C hyst. Median blood loss was significantly less in PND (2000ml vs 3500ml p=0.03). The number of transfusions and GI/GU operative complications was not statistically different. There was no difference in maternal ICU admissions or length of hospital stay.

      Conclusion

      Prenatally diagnosed PA had more risk factors for morbidity but had a higher percentage of non-emergent procedures and experienced significantly less blood loss. A diligent search for evidence of PA in antenatal imaging results in lower maternal morbidity.