Planned conservative management of placenta percreta

Placenta percreta were traditionally managed by immediate hysterectomy. Between 2004 and 2010, eight suspected cases of placenta previa accreta/percreta at our unit have been managed in a standardised way, with a plan to leave the placenta in situ if it does not separate easily. The placenta was removed with minimal difficulty in three cases. In two cases of percreta without bladder invasion, hysterectomy was performed with the placenta still attached to the uterus. In three cases of percreta with bladder invasion, the entire placenta was left in situ. In two of these cases, resolution occurred over an 8 and 12 month' period, respectively but in the third, the postoperative course was complicated by DVT and DIC. This patient then underwent hysterectomy with preoperative uterine artery embolisation, inferior vena cava filter placement and ureteric stenting. Conservative management is an attractive and safe alternative but careful patient selection and individualisation is needed.