The morbidly adherent placenta: diagnosis and management options

Randomized controlled trials and large cohort studies regarding the diagnosis and management of placenta accreta are lacking. This review examines the available evidence.

Avoiding the placenta and leaving it attached at time of elective caesarean section to proceed with either delayed hysterectomy or conservative management is currently recommended. Recent literature has focussed on conservative management. Routine use of methotrexate in conservative management is no longer advocated. Use of emergency balloon catheter placement and embolization in tertiary centres where access to interventional radiology is immediately available may be favourable to prophylactic balloon catheter placement. Follow-up of patients undergoing conservative management should include ultrasonographic follow-up, human chorionic gonadotropin levels have been shown not to correlate with rate of placental resorption.

Women with an antenatal diagnosis of placenta accreta should be managed in a tertiary facility with multidisciplinary input. To determine optimum management strategies, it is imperative that larger studies are carried out in the future. It is essential that the continual monitoring and containment of rising caesarean section rates becomes a priority to prevent a further increase in the incidence of placenta accreta.