Advertisement

Conservative management of morbidly adherent placenta: expert review

Published:April 29, 2015DOI:https://doi.org/10.1016/j.ajog.2015.04.034
      Over the last century, the incidence of placenta accreta, increta, and percreta, collectively referred to as morbidly adherent placenta, has risen dramatically. Planned cesarean hysterectomy at the time of cesarean delivery is the standard recommended treatment in the United States. Recently, interest in conservative management has resurged, especially in Europe. The aims of this review are the following: (1) to provide an overview of methods used for conservative management, (2) to discuss clinical implications for both clinicians and patients, and (3) to identify areas in need of further research.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Khan K.S.
        • Wojdyla D.
        • Say L.
        • Gulmezoglu A.M.
        • Van Look P.F.
        WHO analysis of causes of maternal death: a systematic review.
        Lancet. 2006; 367: 1066-1074
        • Hart D.B.
        Case of successful caesarean section (Porro's modification).
        Br Med J. 1889; 1: 183-184
        • McKeogh R.P.
        • D'Errico E.
        Placenta accreta: clinical manifestations and conservative management.
        N Engl J Med. 1951; 245: 159-165
        • Belfort M.A.
        • Publications Committee for Society for Maternal-Fetal Medicine
        Placenta accreta.
        Am J Obstet Gynecol. 2010; 203: 430-439
        • Fitzpatrick K.E.
        • Sellers S.
        • Spark P.
        • Kurinczuk J.J.
        • Brocklehurst P.
        • Knight M.
        Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study.
        PLoS One. 2012; 7: e52893
        • Kayem G.
        • Davy C.
        • Goffinet F.
        • Thomas C.
        • Clement D.
        • Cabrol D.
        Conservative versus extirpative management in cases of placenta accreta.
        Obstet Gynecol. 2004; 104: 531-536
        • Brody H.
        Placenta accreta: report of five cases and a plan of management.
        Can Med Assoc J. 1963; 89: 499-503
        • Ezechi O.C.
        • Kalu B.K.
        • Njokanma F.O.
        • Nwokoro C.A.
        • Okeke G.C.
        Emergency peripartum hysterectomy in a Nigerian hospital: a 20-year review.
        J Obstet Gynaecol. 2004; 24: 372-373
        • Ajah L.O.
        • Eze M.I.
        • Dim C.C.
        • et al.
        Placenta percreta in a booked multiparous woman with minimal risk factors and challenges of management in a low resource setting.
        Niger J Med. 2012; 21: 359-360
        • Tikkanen M.
        • Paavonen J.
        • Loukovaara M.
        • Stefanovic V.
        Antenatal diagnosis of placenta accreta leads to reduced blood loss.
        Acta Obstet Gynecol Scand. 2011; 90: 1140-1146
        • Warshak C.R.
        • Ramos G.A.
        • Eskander R.
        • et al.
        Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta.
        Obstet Gynecol. 2010; 115: 65-69
        • Fitzpatrick K.E.
        • Sellers S.
        • Spark P.
        • Kurinczuk J.J.
        • Brocklehurst P.
        • Knight M.
        The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study.
        BJOG. 2014; 121 (discussion 70-1): 62-70
        • Shamshirsaz A.A.
        • Salmanian B.
        • Fox K.A.
        • et al.
        Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach.
        Am J Obstet Gynecol. 2015; 212: 218.e1-218.e9
        • Eller A.G.
        • Bennett M.A.
        • Sharshiner M.
        • et al.
        Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care.
        Obstet Gynecol. 2011; 117: 331-337
        • Perez-Delboy A.
        • Wright J.D.
        Surgical management of placenta accreta: to leave or remove the placenta?.
        BJOG. 2014; 121 (discussion 169-70): 163-169
        • Aboulafia Y.
        • Lavie O.
        • Granovsky-Grisaru S.
        • Shen O.
        • Diamant Y.Z.
        Conservative surgical management of acute abdomen caused by placenta percreta in the second trimester.
        Am J Obstet Gynecol. 1994; 170: 1388-1389
        • Lee L.C.
        • Lin H.H.
        • Wang C.W.
        • Cheng W.F.
        • Huang S.C.
        Successful conservative management of placenta percreta with rectal involvement in a primigravida.
        Acta Obstet Gynecol Scand. 1995; 74: 839-841
        • Lee P.S.
        • Bakelaar R.
        • Fitpatrick C.B.
        • Ellestad S.C.
        • Havrilesky L.J.
        • Alvarez Secord A.
        Medical and surgical treatment of placenta percreta to optimize bladder preservation.
        Obstet Gynecol. 2008; 112: 421-424
        • Chandraharan E.
        • Rao S.
        • Belli A.M.
        • Arulkumaran S.
        The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta.
        Int J Gynaecol Obstet. 2012; 117: 191-194
        • Palacios Jaraquemada J.M.
        • Pesaresi M.
        • Nassif J.C.
        • Hermosid S.
        Anterior placenta percreta: surgical approach, hemostasis and uterine repair.
        Acta Obstet Gynecol Scand. 2004; 83: 738-744
        • Jeremiah M.
        Fecundity, barrenness and the importance of motherhood in two Nigerian plays.
        Int J Humanit Soc Sci. 2014; 4: 213-221
        • Sentilhes L.
        • Goffinet F.
        • Kayem G.
        Management of placenta accreta.
        Acta Obstet Gynecol Scand. 2013; 92: 1125-1134
        • Pather S.
        • Strockyj S.
        • Richards A.
        • Campbell N.
        • de Vries B.
        • Ogle R.
        Maternal outcome after conservative management of placenta percreta at caesarean section: a report of three cases and a review of the literature.
        Austr N Z J Obstet Gynaecol. 2014; 54: 84-87
        • Sentilhes L.
        • Ambroselli C.
        • Kayem G.
        • et al.
        Maternal outcome after conservative treatment of placenta accreta.
        Obstet Gynecol. 2010; 115: 526-534
        • Legendre G.
        • Zoulovits F.J.
        • Kinn J.
        • Senthiles L.
        • Fernandez H.
        Conservative management of placenta accreta: hysteroscopic resection of retained tissues.
        J Minim Invas Gynecol. 2014; 21: 910-913
        • Clausen C.
        • Lonn L.
        • Langhoff-Roos J.
        Management of placenta percreta: a review of published cases.
        Acta Obstet Gynecol Scand. 2014; 93: 138-143
        • Lo T.K.
        • Yung W.K.
        • Lau W.L.
        • Law B.
        • Lau S.
        • Leung W.C.
        Planned conservative management of placenta accreta—experience of a regional general hospital.
        J Matern Fetal Neonatal Med. 2014; 27: 291-296
        • Ferrazzani S.
        • Guariglia L.
        • Triunfo S.
        • Caforio L.
        • Caruso A.
        Conservative management of placenta previa-accreta by prophylactic uterine arteries ligation and uterine tamponade.
        Fetal Diagn Ther. 2009; 25: 400-403
        • Albayrak M.
        • Ozdemir I.
        • Koc O.
        • Demiraran Y.
        Post-partum haemorrhage from the lower uterine segment secondary to placenta praevia/accreta: successful conservative management with Foley balloon tamponade.
        Austr N Z J Obstet Gynaecol. 2011; 51: 377-380
        • Vrachnis N.
        • Iavazzo C.
        • Salakos N.
        • Papamargaritis E.
        • Boutas I.
        • Creatsas G.
        Uterine tamponade balloon for the management of massive hemorrhage during cesarean section due to placenta previa/increta.
        Clin Exp Obstet Gynecol. 2012; 39: 255-257
        • Roulot A.
        • Barranger E.
        • Morel O.
        • Soyer P.
        • Hequet D.
        [Two- and three-dimensional power Doppler ultrasound in the follow-up of placenta accreta treated conservatively].
        J Gynecol Obstet Biol Reprod. 2015; 44: 176-183
        • Bretelle F.
        • Courbiere B.
        • Mazouni C.
        • et al.
        Management of placenta accreta: morbidity and outcome.
        Eur J Obstet Gynecol Reprod Biol. 2007; 133: 34-39
        • Alanis M.
        • Hurst B.S.
        • Marshburn P.B.
        • Matthews M.L.
        Conservative management of placenta increta with selective arterial embolization preserves future fertility and results in a favorable outcome in subsequent pregnancies.
        Fertil Steril. 2006; 86: 1514.e3-1514.e7
        • Kim T.H.
        • Lee H.H.
        • Kwak J.J.
        Conservative management of abnormally invasive placenta: choriocarcinoma with uterine arteriovenous fistula from remnant invasive placenta.
        Acta Obstet Gynecol Scand. 2013; 92: 989-990
        • Hequet D.
        • Morel O.
        • Soyer P.
        • Gayat E.
        • Malartic C.
        • Barranger E.
        Delayed hysteroscopic resection of retained tissues and uterine conservation after conservative treatment for placenta accreta.
        Austr N Z J Obstet Gynaecol. 2013; 53: 580-583
        • Rein D.T.
        • Schmidt T.
        • Hess A.P.
        • Volkmer A.
        • Schondorf T.
        • Breidenbach M.
        Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage.
        J Minim Invas Gynecol. 2011; 18: 774-778
        • Hequet D.
        • Ricbourg A.
        • Sebbag D.
        • Rossignol M.
        • Lubrano S.
        • Barranger E.
        [Placenta accreta: screening, management and complications].
        Gynecol Obstet Fertil. 2013; 41: 31-37
      1. Teixidor Viñas M, Belli A, Arulkumaran S, Chandraharan E. Prevention of postpartum haemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure. Ultrasound Obstet Gynecol 2014 [Epub ahead of print].

        • Chandraharan E.
        Should the Triple-P procedure be used as an alternative to peripartum hysterectomy in the surgical treatment of placenta percreta?.
        Womens Health. 2012; 8: 351-353
        • Teixidor Viñas M.
        • Chandraharan E.
        • Moneta M.V.
        • Belli A.M.
        The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta.
        Clin Radiol. 2014; 69: e345-e351
        • Clausen C.
        • Stensballe J.
        • Albrechtsen C.K.
        • Hansen M.A.
        • Lönn L.
        • Langhoff-Roos J.
        Balloon occlusion of the internal iliac arteries in the multidisciplinary management of placenta percreta.
        Acta Obstet Gynecol Scand. 2013; 92: 386-391
        • Sivan E.
        • Spira M.
        • Achiron R.
        • et al.
        Prophylactic pelvic artery catheterization and embolization in women with placenta accreta: can it prevent cesarean hysterectomy?.
        Am J Perinatol. 2010; 27: 455-461
        • Poujade O.
        • Ceccaldi P.F.
        • Davitian C.
        • et al.
        Uterine necrosis following pelvic arterial embolization for post-partum hemorrhage: review of the literature.
        Eur J Obstet Gynecol Reprod Biol. 2013; 170: 309-314
        • Maassen M.S.
        • Lambers M.D.
        • Tutein Nolthenius R.P.
        • van der Valk P.H.
        • Elgersma O.E.
        Complications and failure of uterine artery embolisation for intractable postpartum haemorrhage.
        BJOG. 2009; 116: 55-61
        • Al-Thunyan A.
        • Al-Meshal O.
        • Al-Hussainan H.
        • Al-Qahtani M.H.
        • El-Sayed A.A.
        • Al-Qattan M.M.
        Buttock necrosis and paraplegia after bilateral internal iliac artery embolization for postpartum hemorrhage.
        Obstet Gynecol. 2012; 120: 468-470
        • Arulkumaran S.
        • Ng C.S.
        • Ingemarsson I.
        • Ratnam S.S.
        Medical treatment of placenta accreta with methotrexate.
        Acta Obstet Gynecol Scand. 1986; 65: 285-286
        • Cirpan T.
        • Sanhal C.Y.
        • Yucebilgin S.
        • Ozsener S.
        Conservative management of placenta previa percreta by leaving placental tissue in situ with arterial ligation and adjuvant methotrexate therapy.
        J Turk Ger Gynecol Assoc. 2011; 12: 127-129
        • Heiskanen N.
        • Kroger J.
        • Kainulainen S.
        • Heinonen S.
        Placenta percreta: methotrexate treatment and MRI findings.
        Am J Perinatol. 2008; 25: 91-92
        • Lalchandani S.
        • Geary M.
        • O'Herlihy C.
        • Sheil O.
        Conservative management of placenta accreta and unruptured interstitial cornual pregnancy using methotrexate.
        Eur J Obstet Gynecol Reprod Biol. 2003; 107: 96-97
        • Mussalli G.M.
        • Shah J.
        • Berck D.J.
        • Elimian A.
        • Tejani N.
        • Manning F.A.
        Placenta accreta and methotrexate therapy: three case reports.
        J Perinatol. 2000; 20: 331-334
        • Pinho S.
        • Sarzedas S.
        • Pedroso S.
        • et al.
        Partial placenta increta and methotrexate therapy: three case reports.
        Clin Exp Obstet Gynecol. 2008; 35: 221-224
        • Ramoni A.
        • Strobl E.M.
        • Tiechl J.
        • Ritter M.
        • Marth C.
        Conservative management of abnormally invasive placenta: four case reports.
        Acta Obstet Gynecol Scand. 2013; 92: 468-471
        • Doumouchtsis S.K.
        • Arulkumaran S.
        The morbidly adherent placenta: an overview of management options.
        Acta Obstet Gynecol Scand. 2010; 89: 1126-1133
        • Timmermans S.
        • van Hof A.C.
        • Duvekot J.J.
        Conservative management of abnormally invasive placentation.
        Obstet Gynecol Surv. 2007; 62: 529-539
        • Briggs G.G.
        • Freeman R.K.
        • Yaffe S.J.
        Methotrexate.
        in: Seigafuse S. Shaw R. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk, 8th ed. Lippincott, Williams & Wilkins, Philadelphia, PA2008
        • Lindau J.F.
        • Mastroeni S.
        • Gaddini A.
        • et al.
        Determinants of exclusive breastfeeding cessation: identifying an “at risk population” for special support.
        Eur J Pediatr. 2015; 174: 533-540
        • Sentilhes L.
        • Kayem G.
        • Ambroselli C.
        • et al.
        Fertility and pregnancy outcomes following conservative treatment for placenta accreta.
        Hum Reprod. 2010; 25: 2803-2810
        • Deshpande N.A.
        • Carusi D.A.
        Uterine rupture after prior conservative management of placenta accreta.
        Obstet Gynecol. 2013; 122: 475-478
        • Nisolle M.
        • Delbecque K.
        • Perrier D'Hauterive S.
        • Firquet A.
        • Chantraine F.
        Hysteroscopic resection of abnormally invasive placenta residuals.
        Acta Obstet Gynecol Scand. 2013; 92: 451-456
      2. European Working Group on Abnormally Invasive Placenta. Available at: ew-aip.org. Accessed Jan. 15, 2015.

        • Kayem G.
        • Deneux-Tharaux C.
        • Sentilhes L.
        • PACCRETA Group
        PACCRETA: clinical situations at high risk of placenta ACCRETA/percreta: impact of diagnostic methods and management on maternal morbidity.
        Acta Obstet Gynecol Scand. 2013; 92: 476-482

      Linked Article