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Fertility and obstetric outcome after conservative management of placenta accreta
Magali Provansal1, Blandine Courbiere, Aubert Agostini
1Department of Obstetrics and Gynecology, La Conception University Hospital, Marseille, France.
Objective:
To determine the fertility and obstetric outcomes after conservative management of placenta accreta.
Methods:
A retrospective observational cohort study of all identified cases of placenta accreta from 1993 to 2007 in 2 tertiary university hospitals in France. For patients treated conservatively, maternal and fetal morbidity, reproductive function, fertility, and subsequent pregnancies were recorded.
Results:
During the study period, 46 patients were treated by conservative management; 6 patients underwent a secondary hysterectomy. Of the remaining 40 patients, 35 were followed up for a median of 65 months (range 18-156 months). Patients resumed their menstrual cycles after a median of 130 days (range 48-176 days). Menses were irregular in 11 patients (31%), but none had amenorrhea. Twelve of the 14 patients desiring another pregnancy achieved a total of 15 pregnancies; 2 patients had recurrent placenta accreta. Five spontaneous abortions and 1 termination of pregnancy occurred during the first trimester. The median term at delivery was 37 weeks (range, 35-40 weeks). Four patients delivered prematurely.
Conclusion:
Conservative management of placenta accreta can preserve fertility, although the risk of recurrent placenta accreta appears to be high.
