Conservative approach to the management of morbidly adherent placentae

Objective To determine the effect of conservative management of morbidly adherent placentae on maternal morbidity and mortality and to review management options

Methods All case notes of patients with placenta accreta and percreta between June 2008 and August 2010 were studied retrospectively.

Results eight placentae percretae and 4 placentae accretae were identified out of a total of 11,358 deliveries. All 12 patients underwent caesarean section. Placentae percretae were intentionally left in situ. Interventional radiology was used in these cases. There was one emergency hysterectomy for massive obstetric haemorrhage, one case of disseminated intravascular coagulation, one case of early sepsis and 3 cases of delayed sepsis. Average blood loss was 2490 ml with the mean volume transfused being 1425 ml. The mean hospital stay was 7 days and 2 patients were admitted to intensive care. One patient was readmitted with sepsis complicated by a utero-cutaneous fistula (complete placenta praevia). Another patient required re-embolisation 5 months post delivery for persistent haemorrhage. No ureteric or bladder injuries occurred.

Conclusions Conservative management of placenta percreta is an alternative to caesarean hysterectomy. It is associated with lower maternal morbidity rates. However, monitoring for sepsis and secondary postpartum haemorrhage is essential. Rare complications such as utero-cutanus fistulae may occur.

DOI: http://dx.doi.org/10.4038/cmj.v57i1.4199

CMJ 2012; 57(1): 36-39