[Conservative versus radical management in cases of placenta accreta: a historical study].
OBJECTIVE
To compare the impact of conservative and radical 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 October 2005. 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 October 2005), we changed our policy and attempted to treat patients with a placenta accreta conservatively. The following outcomes over the two periods were compared: need for blood product transfusion, hysterectomy, intensive care admission, duration of stay in intensive care unit, sepsis and disseminated intravascular coagulation.


RESULTS
Fifty-one cases of placenta accreta were observed among 40281 deliveries (1.3/1000). Period B saw a reduction in the hysterectomy rate (11/13 versus 10/38; P < 0.01), the mean red blood cells transfused (3230+/-2170 versus 1081+/-1370 ml; P < 0.01) and disseminated intravascular coagulation (5/13 versus 1/38; P < 0.01) compared with period A. Seven cases of maternal infection were recorded during period B and none during period A (p = 0.22).


CONCLUSIONS
Conservative management of placenta accreta appears to be a safe alternative to radical management.
Kayem
G
G
Service de gynécologie-obstétrique, CHI de Créteil, université Paris-XII-Henri-Mondor, France. gkayem@gmail.com
Anselem
O
O
Schmitz
T
T
Goffinet
F
F
Davy
C
C
Mignon
A
A
Cabrol
D
D
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002985:Clinical Protocols; D015232:Dinoprostone / Q000031:analogs & derivatives / Q000627:therapeutic use; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D008026:Ligation; D010921:Placenta Accreta / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies
D000020:Abortifacient Agents, Nonsteroidal; C016767:sulprostone; D015232:Dinoprostone