I've been doing some research on placental retention, including accreta,
increta and percreta. I was dismayed to discover the connection between
these conditions and c-sections. The connection to previa we can't really
control, but the connection to c-sections?  And the problem with
accreta/increta/percreta is the difficulty in getting the placenta out
without hemorrhage. Sometimes drugs work, but not always. If manual
extraction is attempted and fails acute hemorrhage can require hysterectomy,
losing fertility. An alternative approach of leaving the placenta in situ
may save the uterus but at the expense of lactation. We may be facing this
more in the future.
 
Lisa Marasco
 
Aust N Z J Obstet Gynaecol. 2004 Jun;44(3):210-3.	 	

Is placenta accreta catching up with us?

Armstrong CA, Harding S, Matthews T, Dickinson JE.

King Edward Memorial Hospital for Women, Perth, Western Australia,
Australia. [log in to unmask]

BACKGROUND: Concomitant with the increase in Caesarean birth over the past
three decades there has been an apparent rise in the incidence of placenta
accreta and its variants. The sequelae of an increase in the occurrence of
abnormal placentation is the enhanced potential for severe maternal
morbidity. AIM: To determine the contempory demographics of placenta accreta
over a 5-year period in a tertiary level teaching hospital. METHODS: A
retrospective review of all cases of placenta accreta and variants during
the period of 1998-2002. Individual charts review followed case
ascertainment via the hospital obstetric database. RESULTS: Thirty-two women
with placenta accreta (or variant) were identified. Median maternal age was
34 years, with a median parity of 2.5. Seventy-eight percent of cases had
had at least one prior Caesarean birth, and 88% of cases were associated
with placenta praevia. Pre-delivery ultrasonography was performed in all
cases, providing diagnostic sensitivity of 63% and specificity of 43% with a
predictive value of 76%. Hysterectomy was performed in 91% of cases with
median intraoperative blood loss of 3000 mL. There were no maternal deaths
in the current series. CONCLUSION: A strong association between placenta
accreta, placenta praevia and prior Caesarean birth has been demonstrated.
As there is the potential for significant maternal morbidity the risk of
placenta accreta needs to be recognised and women at risk should be
considered for delivery at an institution with appropriate expertise and
resources in managing this condition.


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