The management of placenta percreta: Conservative and operative strategies☆,☆☆,★
Section snippets
PATIENTS AND METHODS
In June 1995, 1450 questionnaires were mailed to members of the Society of Perinatal Obstetricians. The survey assessed the experience of the membership in treating placenta percreta within the past 3 years. For individuals with recent experience the method and timing of the diagnosis, mode of management, and associated morbidity and mortality were assessed in reported cases. Preferences for surgical versus conservative therapy were also determined given four hypothetic clinical situations. For
RESULTS
A total of 335 surveys were returned (23%) providing information on 109 cases of placenta percreta encountered during the preceding 3 years. The diagnosis of placenta percreta was suspected ante partum in 55 cases (50%). An abnormal ultrasonographic examination was noted in 44 of these cases (80%) and an elevated maternal serum α-fetoprotein (AFP) level was reported in 6 cases (11%). Magnetic resonance imaging (MRI) was used with 5 patients to assist in the diagnosis. The majority of cases were
CASE SERIES
Three cases of placenta percreta were identified at our institution during the study interval (1:3052 births). The diagnosis of placenta percreta was suspected ante partum in two women and the only perinatal death occurred in our unrecognized case.
COMMENT
Our findings affirm that placenta percreta is associated with a substantial risk for fetal and maternal death. In addition, morbidities such as uterine rupture, urinary tract injury, serious infectious complications, and massive transfusion are common.
The current investigation attempts to identify strategies that may be associated with an improved outcome in these patients. Perhaps the single greatest factor affecting outcome is the antepartum identification of abnormal placentation. The
References (25)
- et al.
Conservative surgical management of acute abdomen caused by placenta percreta in the second trimester
Am J Obstet Gynecol
(1994) Placental percreta induced uterine rupture and resultant intraabdominal abortion
Am J Obstet Gynecol
(1989)- et al.
Midtrimester hemoperitoneum caused by placenta percreta in association with elevated maternal serum α-fetoprotein
Am J Obstet Gynecol
(1994) - et al.
Placenta percreta associated with a second-trimester pregnancy termination
Am J Obstet Gynecol
(1984) - et al.
Placenta percreta invading the bladder: report of 2 cases
J Urol
(1989) - et al.
Angiographic embolization in the management of hemorrhagic complications of pregnancy
Am J Obstet Gynecol
(1992) - et al.
Case report: post partum intra-abdominal hemorrhage due to placenta percreta
Eur J Obstet Gynecol
(1995) - et al.
Failure of methotrexate for the term placenta percreta
Am J Obstet Gynecol
(1994) - et al.
Placenta accreta, increta, and percreta: a survey of 40 cases
Obstet Gynecol
(1977) Placenta accreta, 1949-1969
Obstet Gynecol Surv
(1972)
Placenta previa accreta and prior cesarean section
Obstet Gynecol
Simultaneously occurring placenta previa and placenta accreta
Surg Gynecol Obstet
Cited by (0)
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From the Divisions of Maternal-Fetal Medicinea and Gynecologic Oncology,b Department of Obstetrics and Gynecology, Central Baptist Hospital.
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Reprint requests: John M. O'Brien, MD, Perinatal Diagnostic Center, Central Baptist Hospital, 1740 Nicholasville Road, Lexington, KY 40503.
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0002-9378/96 $5.00 + 0 6/1/76386