Management of placenta accreta: a survey of Maternal-Fetal Medicine practitioners

Abstract

Objective: To describe the management strategies for placenta accreta used by Maternal-Fetal Medicine practitioners. Methods: We conducted a 36-question online survey of members of the Society for Maternal-Fetal Medicine regarding management of placenta accreta, and tabulated the results. Results: We had 508 respondents. Most respondents have been in practice for >20 years (30%), at a university-affiliated institution (58.1%). In the previous 2 years, 44.6% of respondents operated on 1–3 cases of placenta accreta, with 3% having operated on greater than 10 cases. Magnetic resonance imaging (MRI) is used as a diagnostic adjunct when the suspicion for accreta is both low (43.1%) and high (68%). In asymptomatic patients with high suspicion for accreta, 15.4% of practitioners hospitalize patients antenatally, 34.5% administer corticosteroids, and 46.8% perform amniocentesis for fetal lung maturity prior to delivery, which they schedule most commonly at 36 weeks (48.4%). Equipment requested prior to delivery includes intravascular balloon catheters (35%) and ureteral stents or catheters (26.2%). With high suspicion for accreta intraoperatively, the majority proceed with hysterectomy, but 14.9% report conservative management. Conclusion: Survey respondents employ diverse approaches in the management of patients with placenta accreta. Further study may lead to consensus strategies to improve outcome in this high-risk obstetric condition.

Keywords::

• abnormal placentation
• cesarean hysterectomy
• ultrasound
• intravascular balloon
• critical care

Declaration of interest: Departmental funds were used for this study. The authors report no declarations of interest.