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The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study.

Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M.

BJOG. 2014 Jan;121(1):62-71.

Editor’s comment: Prof. Jim Thornton: Diagnose placenta accreta antenatally, institute bleeding prevention measures, but don’t always attempt removal
Among 134 women with placenta accreta, increta, or percreta, half were suspected antenatally. Women who had an antenatal diagnosis had less bleeding and transfusion, probably because they had more preventive therapies for haemorrhage, and because the obstetrician was less likely to attempt to remove their placenta.

Abstract

OBJECTIVE:

To describe the management and outcomes of placenta accreta, increta, and percreta in the UK.

DESIGN:

A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS).

SETTING:

All 221 UK hospitals with obstetrician-led maternity units.

POPULATION:

All women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011.

METHODS:

Prospective case identification through the monthly mailing of UKOSS.

MAIN OUTCOME MEASURES:

Median estimated blood loss, transfusion requirements.

RESULTS:

A cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100 ml, P = 0.008) and a reduced need for blood transfusion (59 versus 94%, P = 0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P = 0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P < 0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700 ml, P = 0.001) and a reduced need for blood transfusion (57 versus 86%, P < 0.001).

CONCLUSIONS:

Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.

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Commentaries by Editor Prof. Jim Thornton