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Management of placenta accreta
Loïc Sentilhes1, François Goffinet, Gilles Kayem
1Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France.
Acta Obstetricia Et Gynecologica Scandinavica
|July 23, 2013
Summary
Cesarean hysterectomy is standard for placenta accreta, but conservative treatment offers future pregnancy options. Both approaches require careful consideration of risks and management strategies for abnormally invasive placentas.
Area of Science:
- Maternal-Fetal Medicine
- Gynecologic Surgery
Background:
- Placenta accreta spectrum disorders present significant maternal risks.
- Cesarean hysterectomy is the established treatment, but limits future fertility.
Purpose of the Study:
- To review and discuss the management options for placenta accreta spectrum disorders.
- To highlight the considerations for conservative management in women desiring future fertility.
Main Methods:
- Review of current literature and clinical guidelines.
- Discussion of controversial aspects of both surgical and conservative management.
Main Results:
- Conservative management is a viable option for selected patients, particularly in cases of placenta percreta with bladder involvement.
- Key management decisions include timing of delivery, placental management, and adjunct therapies like internal iliac balloon occlusion and methotrexate.
Conclusions:
- Both cesarean hysterectomy and conservative treatment have roles in managing placenta accreta.
- Informed consent regarding high maternal complication risks is crucial for all patients with abnormally invasive placentas.
