Planned conservative management of placenta accreta – experience of a regional general hospital

Abstract

Objective: There are only a few series treating ≥10 cases of accreta conservatively, all from university teaching hospitals, with reported success rate of 60–85%. We reported the first series of accreta managed by planned uterine conservation in the setting of non-university district general hospital.

Methods: Women with placenta previa overlying previous cesarean scar who desired uterine conservation were included. For cases with accreta confirmed during cesarean delivery, placenta was purposefully left behind, followed immediately by uterine artery embolization. Cases were followed in our special postnatal clinic. Charts were reviewed to retrieve clinical details.

Results: Among 15 cases of placenta previa overlying cesarean scar opting for conservative management, 12 (80%) were confirmed to be accreta intra-operatively. They had 20–100% of the adherent placentae retained (median 90%) and their uterus preserved. Postpartum, abnormal vaginal bleeding and/or infection led to unscheduled readmission in 67% (8/12), all managed conservatively. Sonographic resolution of placenta took 2–13 months (median 6.6), and was later than menstrual return in 11 cases.

Conclusions: Successful planned conservative management of placenta accreta is feasible in the setting of district general hospital with facilities for interventional radiology.

• Adherent placenta
• hysterectomy
• placental conservation
• previous cesarean section
• uterine artery embolization