[Analysis of placenta accreta risk factors. 8 case reports]

The authors report 8 cases of placenta accreta during a 7-year period between March 1986 and January 1992. There were 72,399 deliveries at the Rabta Tunis Maternity and Neonatalogy Centre during this same period, i.e. a rate of 0.11%. Risk factors were dominated by multiparity (7 cases), uterine scars (7 cases) and placenta praevia (5 cases). Associated rupture of the uterus was seen in 2 cases. There was no ultrasonographic diagnosis of placenta accreta before delivery. The diagnosis invariably made at the time of delivery was confirmed histologically in all cases. Hysterectomy was performed in 7 cases and a partial resection of the uterine horn in 1 case. Maternal mortality was nil. There was perinatal mortality in 4 cases, linked twice to prematurity and twice to hypoxia secondary to severe hemorrhage. Analysis of these 8 cases and a review of the literature form the basis of a discussion of the epidemiological profile and clinical and paraclinical characteristics of this condition and an evaluation of foeto-maternal prognosis.