[Placenta accreta: Frequency, prenatal diagnosis and management]

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Diagnostic Imaging

Context:

• Placenta accreta incidence has risen dramatically, exceeding 1 in 2500 deliveries.
• This increase correlates with the rise in cesarean delivery rates.
• Accurate prenatal diagnosis is essential for optimal management.

Purpose:

• To review diagnostic tools for placenta accreta, including 2D and 3D ultrasound, and MRI.
• To discuss management strategies, emphasizing patient involvement in decision-making.
• To outline treatment options based on patient characteristics and desire for future pregnancy.

Summary:

• 2D-ultrasonography with abnormal placental lacunae is a key diagnostic sign.
• 3D power Doppler enhances diagnostic performance, and combining ultrasound findings improves accuracy.
• Magnetic resonance imaging (MRI) is valuable for inconclusive ultrasound cases.
• Prenatal diagnosis necessitates abandoning manual placental removal.
• Treatment decisions involve cesarean hysterectomy or conservative management, tailored to patient needs.
• Conservative treatment may be optimal for placenta percreta involving the bladder.

Impact:

• Improved diagnostic accuracy through advanced imaging techniques.
• Enhanced patient counseling and shared decision-making for placenta accreta management.
• Personalized treatment approaches, balancing maternal safety with reproductive desires.