Surgical management of placenta accreta: a 10-year experience

Acta Obstet Gynecol Scand. 2013 Apr;92(4):445-50. doi: 10.1111/aogs.12075. Epub 2013 Jan 24.


Objective: To examine maternal morbidity in primary surgical management of placenta accreta.

Design: Retrospective case series.

Setting: Quaternary perinatal referral center in Melbourne, Australia.

Population: Clinically suspected and histologically confirmed cases of placenta accreta, increta and percreta.

Methods: Women were identified from our hospital database coded for placenta accreta, increta, percreta and peripartum hysterectomy. Relevant details were sought from medical records.

Main outcome measures: Predefined maternal morbidities: blood loss, transfusion requirements, surgical complications, reoperation rate, duration in hospital. Predefined neonatal outcomes: gestational age at birth, birth-weight, admission to intensive (NICU) or special care nurseries (SCN), respiratory distress syndrome.

Results: Between 1999 and 2009, 33 women were diagnosised with invasive placentation. A total of 27 were confirmed histologically after hysterectomy: 12 accreta, one increta, and 14 percreta. Median blood loss was 2 L. There was a 1.8-L reduction in mean blood loss with elective vs. emergency hysterectomy (p = 0.04). Nearly two-thirds of women required four or more units of packed red-blood-cells. Half of the women suffered from surgical complications, mostly from bladder injury. The risk of returning to theater for further surgery was 20%. Women with placenta percreta were more likely to require additional blood products (p = 0.03), sustain renal tract injury (p = 0.003) and require intensive care admission (p = 0.002).

Conclusions: A primary surgical approach to management of placenta accreta is associated with significant maternal morbidity, even when managed in a dedicated quaternary perinatal referral center.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Australia
  • Blood Loss, Surgical / prevention & control
  • Blood Loss, Surgical / statistics & numerical data*
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Placenta Accreta / diagnostic imaging
  • Placenta Accreta / epidemiology
  • Placenta Accreta / surgery*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control
  • Postpartum Hemorrhage / diagnostic imaging
  • Postpartum Hemorrhage / epidemiology
  • Postpartum Hemorrhage / surgery*
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Prenatal Care / statistics & numerical data
  • Retrospective Studies
  • Treatment Outcome
  • Ultrasonography, Prenatal
  • Uterus / blood supply
  • Young Adult