A Single Center Experience on the Management of Placental Invasion Abnormalities

Year 2016, Volume: 7 Issue: 1, 14 - 18, 01.03.2016

Alper Biler Atalay Ekin , Cenk Gezer , Ulaş Solmaz , Nuri Peker , Aykut Özcan Mehmet Özeren

https://doi.org/10.5799/jcei.328659

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. 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. Silver RM, Barbour KD. Placenta accreta spectrum: accrete, increta, and percreta. Obstet Gynecol Clin North Am 2015;42:381-402.
• 3. Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Ed Obstet Gynecol 2006;107:927–941.
• 4. Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006;107:1226–1232.
• 5. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twentyyear analysis. Am J Obstet Gynecol 2005;192:1458–1461.
• 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. Timmermans S, van Hof AC, Duvekot JJ. Conservative management of abnormally invasive placentation. Obstet Gynecol Surv 2007;62:529–539.
• 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. 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. Chou MM, Ho ES, Lee YH. Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound. Obstet Gynecol 2000;15:25-35.
• 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. 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. Comstock CH, Bronsteen RA. The antenatal diagnosis of placenta accreta. BJOG 2014;121:171-181.
• 14. Bailit JL, Grobman WA, Rice MM, et al. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 2015;125:683-689.
• 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. Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG 2009;116:648-654.
• 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. Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am 2015;42:381-402.
• 19. Erdemoğlu M, Kale A, Akdeniz N. Analysis of 46 hysterectomies performed for obstetric indications. Dicle Med J 2006;33:227-230.
• 20. Evsen MS, Sak ME, Özkul Ö, Et al. Emergency peripartum hysterectomy. Dicle Med J 2009;36:23-27.
• 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. 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. Shabana A, Fawzy M, Refaie W. Conservative management of placenta percreta: a stepwise approach. Arch Gynecol Obstet 2015;29:993-998.
• 24. Sentilhes L, Ambroselli C, Kayem G, et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 2010;115:526-534.
• 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. 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.