[Placenta previa accreta]

The purpose of our study was to assess the relationship between previous cesarean section and placenta previa accreta and to estimate the incidence of placenta accreta et previa accreta as the indication for peripartum hysterectomy.

The records of all patients delivered with the diagnosis of placenta previa accreta during the period from 1992-2002 at Hospital in Chojnice were reviewed. Statistical analyses were carried out to determine the relationship between previous cesarean section and subsequent development of placenta previa accreta. We conducted a retrospective analysis of indications for peripartum hysterectomy.

From a total 28,177 women, who delivered at the Chojnice Hospital, 15(0.05%) patients had placenta accreta, 63(0.2%) placenta previa. Among placenta previa deliveries 22(34.9%) patients had previous cesarean section. Out of 15 patients with placenta accreta 10(66.7%) had placenta previa. Incidence of placenta accreta per case of placenta previa was 158.7 per 1000. The incidence of placenta previa accreta significantly increased in those with previous post cesarean scars. This incidence increased as the number of previous cesarean sections increased. The most common indication for peripartum hysterectomy was placenta accreta--48.4%, incidence of placenta previa accreta was accounts for 32.3% of all indications.

The association between placenta previa accreta and prior cesarean section was confirmed. The incidence of placenta accreta increased as the number of previous cesarean sections increased. Patients with an antepartum diagnosis of placenta previa, who have had a previous cesarean section should be considered at high risk for developing placenta accreta. The most common indication for peripartum hysterectomy in this study was placenta previa accreta.