Management of placenta percreta: a review of published cases

TY - JOUR

T1 - Management of placenta percreta

T2 - a review of published cases

AU - Clausen, Caroline

AU - Lönn, Lars

AU - Langhoff-Roos, Jens

N1 - © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

PY - 2014/2

Y1 - 2014/2

N2 - Publications on abnormally invasive placenta in general report what can be considered a mixture of the conditions true accreta, increta and percreta varieties. The aim of this review was to identify all published cases of the most severe condition, placenta percreta in order to describe complications associated with the three commonly used surgical strategies: local resection, hysterectomy or leaving the placenta in situ, and to describe the outcome, with respect to blood loss and transfusion requirements, with the different endovascular interventions that may be used as adjuncts in the management of the conditions. A PubMed search was performed in April 2013 and the final review included 119 published placenta percreta cases. Conservative management, where the placenta is left in situ for resorption, seems to be associated with severe long-term complications of hemorrhage and infections, including a 58% risk that a hysterectomy will eventually be needed up till nine months after the delivery. Local resection seems to be associated with fewer complications within 24 h postoperatively compared with hysterectomy or leaving the placenta in situ. A selection bias in the direction of less severe cases for the local resection technique might in part explain the lower complication rates with that approach. Future prospective data collection activities should include intended as well as actual management, and long-term follow-up of all cases is of vital importance.

AB - Publications on abnormally invasive placenta in general report what can be considered a mixture of the conditions true accreta, increta and percreta varieties. The aim of this review was to identify all published cases of the most severe condition, placenta percreta in order to describe complications associated with the three commonly used surgical strategies: local resection, hysterectomy or leaving the placenta in situ, and to describe the outcome, with respect to blood loss and transfusion requirements, with the different endovascular interventions that may be used as adjuncts in the management of the conditions. A PubMed search was performed in April 2013 and the final review included 119 published placenta percreta cases. Conservative management, where the placenta is left in situ for resorption, seems to be associated with severe long-term complications of hemorrhage and infections, including a 58% risk that a hysterectomy will eventually be needed up till nine months after the delivery. Local resection seems to be associated with fewer complications within 24 h postoperatively compared with hysterectomy or leaving the placenta in situ. A selection bias in the direction of less severe cases for the local resection technique might in part explain the lower complication rates with that approach. Future prospective data collection activities should include intended as well as actual management, and long-term follow-up of all cases is of vital importance.

KW - Blood Loss, Surgical

KW - Blood Volume

KW - Cesarean Section

KW - Female

KW - Humans

KW - Hysterectomy

KW - Placenta Accreta

KW - Pregnancy

KW - Pregnancy Complications

KW - Treatment Outcome

KW - Uterine Artery Embolization

U2 - 10.1111/aogs.12295

DO - 10.1111/aogs.12295

M3 - Review

C2 - 24266548

SN - 0001-6349

VL - 93

SP - 138

EP - 143

JO - Acta Obstetrica et Gynecologica

JF - Acta Obstetrica et Gynecologica

IS - 2

ER -