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[Management of placenta accreta]
G Kayem1, G Grangé, F Goffinet
1Service de Gynécologie-Obstétrique, Centre Hospitalier Intercommunal de Créteil, Créteil, France. kayem@cochin.inserm.fr
Gynecologie, Obstetrique & Fertilite
|February 24, 2007
Summary
Placenta accreta, a condition of abnormal placental invasion, is linked to placenta previa and prior C-sections. Diagnosis uses ultrasound and MRI, with treatment options ranging from hysterectomy to conservative management for fertility preservation.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Context:
- Placenta accreta is characterized by abnormal placental implantation due to a defect in the decidua basalis.
- Key risk factors include placenta previa and a history of cesarean section.
Purpose:
- To evaluate the diagnostic value of conventional sonographic criteria for abnormally adherent placenta.
- To highlight the role of MRI in improving diagnosis when sonography is inconclusive.
- To discuss treatment strategies for placenta accreta, considering medical and patient preferences.
Summary:
- Conventional ultrasound criteria for placenta accreta have good diagnostic value but require assessment.
- MRI can enhance diagnostic accuracy when sonography yields inconclusive results.
- Treatment decisions involve healthcare providers and patients, necessitating specialized centers. Options include cesarean hysterectomy or placental delivery with potential hysterectomy, alongside conservative management for fertility preservation.
Impact:
- Effective diagnosis and management of placenta accreta are crucial for preventing severe maternal complications and mortality.
- Conservative management offers fertility preservation in selected cases, requiring rigorous follow-up.
- Timely hysterectomy is vital in cases of major hemorrhage to avert maternal death.
