title: Conservative versus extirpative management in cases of placenta accreta.
abstract: OBJECTIVE
  To compare the impact of conservative and extirpative strategies for placenta accreta on maternal morbidity and mortality.
  
  
  METHODS
  We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta admitted to our tertiary center from January 1993 through December 2002. Two consecutive periods, A and B, were compared. During period A (January 1993 to June 1997), our written protocol called for the systematic manual removal of the placenta, to leave the uterine cavity empty. In period B (July 1997 to December 2002), we changed our policy by leaving the placenta in situ. The following outcomes over the 2 periods were compared: need for blood transfusion, hysterectomy, intensive care admission, duration of stay in intensive care, and postpartum endometritis.
  
  
  RESULTS
  Thirty-three cases of placenta accreta were observed among 31,921 deliveries (1.03/1,000). During period B, there was a reduction in the hysterectomy rate (from 11 [84.6%] to 3 [15%]; P <.001), the mean number of red blood cells transfused (3,230 +/- 2,170 mL versus 1,560 +/- 1,646 mL; P <.01), and disseminated intravascular coagulation (5 [38.5%] versus 1 [5.0%]; P =.02), compared with period A. There were 3 cases of sepsis in period B and none in period A (P =.26). At least 2 women with conservative management subsequently had successful pregnancies.
  
  
  CONCLUSIONS
  Leaving the placenta accreta in situ appears to be a safe alternative to removing the placenta.
authors.affiliation: Department of Obstetrics and Gynaecology, Maternité Port-Royal Hospital, Cochin APHP University René Descartes, Paris, France. gilles.kayem@chicreteil.fr
authors.forename: Gilles
authors.initials: G
authors.lastname: Kayem
authors.forename: Céline
authors.initials: C
authors.lastname: Davy
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
authors.forename: Carole
authors.initials: C
authors.lastname: Thomas
authors.forename: Denis
authors.initials: D
authors.lastname: Clément
authors.forename: Dominique
authors.initials: D
authors.lastname: Cabrol
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010921:Placenta Accreta / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies