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Planned conservative management of placenta percreta
1Department of Obstetrics and Gynaecology, Limerick Regional Maternity Hospitals, Limerick, Republic of Ireland. vuivunwong@yahoo.com
Summary
Placenta percreta management evolved from hysterectomy to conservative approaches. Leaving the placenta in situ can lead to resolution in select cases, offering a safe alternative with careful patient selection.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Traditionally, placenta percreta, a condition where the placenta invades the uterine wall, necessitated immediate hysterectomy.
- This approach carried significant risks and morbidity for patients.
Observation:
- A standardized management protocol was implemented for suspected placenta previa accreta/percreta cases between 2004 and 2010.
- The protocol involved leaving the placenta in situ if it did not separate easily, reserving hysterectomy for specific situations.
Findings:
- In three cases without bladder invasion, hysterectomy was performed with the placenta attached.
- In three cases with bladder invasion, the placenta was intentionally left in situ, resulting in resolution in two cases over 8-12 months.
- One case of conservative management was complicated by deep vein thrombosis (DVT) and disseminated intravascular coagulation (DIC), requiring subsequent hysterectomy with interventional procedures.
Implications:
- Conservative management of placenta percreta, by leaving the placenta in situ, presents an attractive and potentially safe alternative to hysterectomy.
- Careful patient selection and individualized treatment plans are crucial for successful conservative management.
- This approach may reduce the need for hysterectomy and its associated complications in selected cases of placenta percreta.
