Urologic considerations of placenta accreta: a contemporary tertiary care institutional experience

As the incidence of cesarean delivery has increased, we are experiencing a higher incidence of subsequent placenta accreta and the associated complications, including urologic complications.

This is a retrospective review of all patients delivered from 2000 to 2011 with a histologically proven diagnosis of placenta accreta. Data were analyzed for baseline maternal characteristics, intraoperative and postoperative outcomes and complications.

83 patients were included in the analysis. The depth of placenta accreta invasion varied in the cohort, with 48, 25 and 27% being classified as placenta accreta, placenta increta and placenta percreta, respectively. 88% of patients had had a previous cesarean delivery, and 58% had more than one prior operative delivery. Cystotomy was encountered in 27% of patients and ureteral injury occurred in 4%. Degree of placenta accreta invasion, number of prior cesarean deliveries and intraoperative blood loss were associated with a higher likelihood of urologic injury.

Urologic injuries are among the most frequently encountered intraoperative complications of placenta accreta. Surgeons involved in these cases need to be aware of this risk and maintain a high level of surveillance intraoperatively.