A Single Center Experience on the Management of Placental Invasion Abnormalities

Abstract

Objective: The aim of this study is to investigate our management of placental invasion abnormalities. Methods: A retrospective study was conducted on patients admitted to a tertiary referral center with a diagnosis of placental invasion abnormalities between 2011 and 2015. Risk factors and perinatal outcomes associated with placental invasion abnormalities were identified. Results: The overall incidence of placental invasion abnormalities during the 5-year period was 8.3/10000 deliveries, which showed an increasing trend. Ultrasonography and magnetic resonance imaging correctly identified placental invasion abnormality in 36.7% and 68.7% cases, respectively. Majority of patients (55.1%) with adherent placenta were diagnosed at the time of delivery. Of these patients, 22.4% underwent hysterectomy, 83.8% required at least one of the additional surgical procedures and 55% were transfused at least four units of packed red blood cell. Conclusion: Since placental invasion abnormalities are associated with significant morbidity, delivery should be scheduled in a tertiary center with appropriate expertise and facilities. J Clin Exp Invest 2016; 7 (1): 14-18

Keywords

• placenta accreta,placenta increta,placenta percreta,placental invasion abnormality

References

1. 1. Esmans A, Gerris J, Corthout E, et al. Placenta percreta causing rupture of an unscarred uterus at the end of the first trimester of pregnancy: case report. Hum Reprod 2004;19:2401-2403.
2. 2. Silver RM, Barbour KD. Placenta accreta spectrum: accrete, increta, and percreta. Obstet Gynecol Clin North Am 2015;42:381-402.
3. 3. Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Ed Obstet Gynecol 2006;107:927–941.
4. 4. Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006;107:1226–1232.
5. 5. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twentyyear analysis. Am J Obstet Gynecol 2005;192:1458–1461.
6. 6. Kayem G, Davy C, Goffinet F, et al. Conservative versus extirpative management in cases of placenta accreta. Obstet Gynecol 2004;104:531–536.
7. 7. Timmermans S, van Hof AC, Duvekot JJ. Conservative management of abnormally invasive placentation. Obstet Gynecol Surv 2007;62:529–539.
8. 8. Cali G, Giambanco L, PuccioG, Forlani F. Morbidly adherent placenta: evaluation of ultrasound diagnostic criteria and differentiation of placenta accreta from percreta. Ultrasound Obstet Gynecol 2013;41:406–412.

9. 9. Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med 1992;11:333-343.
10. 10. Chou MM, Ho ES, Lee YH. Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound. Obstet Gynecol 2000;15:25-35.
11. 11. Warshak CR, Eskander R, Hull AD, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 2006;108:573–581.
12. 12. Peker N, Turan V, Ergenoglu M, et al. Assessment of total placenta previa by magnetic resonance imaging and ultrasonography to detect placenta accreta and its variants. Ginekol Pol. 2013;84:186- 192.
13. 13. Comstock CH, Bronsteen RA. The antenatal diagnosis of placenta accreta. BJOG 2014;121:171-181.
14. 14. Bailit JL, Grobman WA, Rice MM, et al. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 2015;125:683-689.
15. 15. Grace Tan SE, Jobling TW, Wallace EM, et al. Surgical management of placenta accreta: a 10-year experience. Acta Obstet Gynecol Scand 2013;92:445-450.
16. 16. Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG 2009;116:648-654.
17. 17. Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 2015;212:218.e1-9.
18. 18. Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am 2015;42:381-402.
19. 19. Erdemoğlu M, Kale A, Akdeniz N. Analysis of 46 hysterectomies performed for obstetric indications. Dicle Med J 2006;33:227-230.
20. 20. Evsen MS, Sak ME, Özkul Ö, Et al. Emergency peripartum hysterectomy. Dicle Med J 2009;36:23-27.
21. 21. İncebıyık A, Camuzcuoğlu A, Hilali NG, et al. Approach to cases with postpartum haemorrhage: retrospective analysis of 41 cases. J Clin Exp Invest 2014;5:18-23.
22. 22. D’Souza DL, Kingdom JC, Amsalem H, et al. Conservative Management of Invasive Placenta Using Combined Prophylactic Internal Iliac Artery Balloon Occlusion and Immediate Postoperative Uterine Artery Embolization. Can Assoc Radiol J 2015;66:179- 184.
23. 23. Shabana A, Fawzy M, Refaie W. Conservative management of placenta percreta: a stepwise approach. Arch Gynecol Obstet 2015;29:993-998.
24. 24. Sentilhes L, Ambroselli C, Kayem G, et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 2010;115:526-534.
25. 25. Provansal M, Courbiere B, Agostini A, et al. Fertility and obstetric outcome after conservative management of placenta accreta. Int J Gynaecol Obstet 2010;109:147-150.
26. 26. Kabiri D, Hants Y, Shanwetter N, et al. Outcomes of subsequent pregnancies after conservative treatment for placenta accreta. Int J Gynaecol Obstet 2014;127:206-210.