Conservative management of placenta accreta

Two case reports of conservative management of placenta accreta in primiparous women are reported. Initial attempts to evacuate the uterus via manual removal and routine oxytocics were unsuccessful. The patients were counselled regarding further management options, surgical (hysterectomy), radiological guided arterial embolisation, medical (methotrexate, prostaglandins, mifepristone) and conservative ("watchful waiting"). After a long discussion regarding the risks of haemorrhage and infection and emergency hysterectomy, both patients opted for a conservative approach and were discharged from hospital with the placenta still in situ. The patients were followed with weekly clinical and ultrasonic assessment. One patient had a spontaneous evacuation 43 days postnatally and the second 80 days postnatally. The fertility of both women was conserved but neither have attempted further pregnancy to date.