Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
, 104 (3), 531-6

Conservative Versus Extirpative Management in Cases of Placenta Accreta

Affiliations
Comparative Study

Conservative Versus Extirpative Management in Cases of Placenta Accreta

Gilles Kayem et al. Obstet Gynecol.

Abstract

Objective: To compare the impact of conservative and extirpative strategies for placenta accreta on maternal morbidity and mortality.

Methods: We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta admitted to our tertiary center from January 1993 through December 2002. Two consecutive periods, A and B, were compared. During period A (January 1993 to June 1997), our written protocol called for the systematic manual removal of the placenta, to leave the uterine cavity empty. In period B (July 1997 to December 2002), we changed our policy by leaving the placenta in situ. The following outcomes over the 2 periods were compared: need for blood transfusion, hysterectomy, intensive care admission, duration of stay in intensive care, and postpartum endometritis.

Results: Thirty-three cases of placenta accreta were observed among 31,921 deliveries (1.03/1,000). During period B, there was a reduction in the hysterectomy rate (from 11 [84.6%] to 3 [15%]; P <.001), the mean number of red blood cells transfused (3,230 +/- 2,170 mL versus 1,560 +/- 1,646 mL; P <.01), and disseminated intravascular coagulation (5 [38.5%] versus 1 [5.0%]; P =.02), compared with period A. There were 3 cases of sepsis in period B and none in period A (P =.26). At least 2 women with conservative management subsequently had successful pregnancies.

Conclusion: Leaving the placenta accreta in situ appears to be a safe alternative to removing the placenta.

Comment in

Similar articles

  • [Conservative Versus Radical Management in Cases of Placenta Accreta: A Historical Study]
    G Kayem et al. J Gynecol Obstet Biol Reprod (Paris) 36 (7), 680-7. PMID 17573204.
    Conservative management of placenta accreta appears to be a safe alternative to radical management.
  • Management of Placenta Accreta: Morbidity and Outcome
    F Bretelle et al. Eur J Obstet Gynecol Reprod Biol 133 (1), 34-9. PMID 16965851.
    Analysis of management of placenta accreta shows that for a subgroup of selected patients a conservative approach could preserve subsequent fertility without evident incr …
  • [Conservative Treatment of Placenta Accreta]
    B Courbière et al. J Gynecol Obstet Biol Reprod (Paris) 32 (6), 549-54. PMID 14593301.
    Conservative treatment of placenta accreta appears to be a efficient way to preserve fertility. Antepartum diagnosis should be improved among patients with a high risk of …
  • Placenta Accreta and Postpartum Hemorrhage
    AD Hull et al. Clin Obstet Gynecol 53 (1), 228-36. PMID 20142659. - Review
    Placenta accreta is the abnormal adherence of the placenta to the uterine wall. Where placenta accreta is present, the failure of the placenta to separate normally from t …
  • Conservative Management of Abnormally Invasive Placentation
    S Timmermans et al. Obstet Gynecol Surv 62 (8), 529-39. PMID 17634154. - Review
    Due to the growing number of cesarean deliveries, the frequency of abnormally invasive placentation is increasing. The optimal management of this condition remains unclea …
See all similar articles

Cited by 28 PubMed Central articles

See all "Cited by" articles

Publication types

LinkOut - more resources

Feedback