title: The maternal outcome in placenta accreta: the significance of antenatal diagnosis and non-separation of placenta at delivery.
abstract: OBJECTIVE
  To evaluate the effects of antenatal diagnosis and subsequent placental non-separation at delivery on the maternal outcome in confirmed cases of placenta accreta.
  
  
  METHODS
  The perinatal database and medical records for women who delivered in the period 2000-6 in a teaching hospital in New Zealand with a diagnosis of placenta accreta or postpartum haemorrhage or hysterectomy were reviewed. In confirmed placenta accreta cases, the amount of blood loss and blood transfused at delivery and subsequent emergency hysterectomy were analysed in respect to the presence/absence of antenatal diagnosis and the management at delivery.
  
  
  RESULTS
  16 women had placenta accreta confirmed (15 histologically and 1 visually). Antenatal diagnosis was made in 7 women, elective Caesarean delivery planned in all, hysterectomy to follow in 5 (4 elective, 1 emergency preterm), and elective placental separation in 2 women. When an antenatal diagnosis was not made (n=9), attempted placental separation led to emergency hysterectomy for all (p=0.001). Antenatal diagnosis and placental non-separation resulted in less mean blood loss (1.4 L vs 3.6 L, p=0.003; 1.0 L vs 3.4 L, p<0.001) and mean units of blood transfused (1.2 vs 5.1, p=0.005) in the latter.
  
  
  CONCLUSIONS
  In placenta accreta, antenatal diagnosis and avoidance of placental separation may result in better maternal outcome.
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Otago, Wellington, PO Box 7343, Wellington South, New Zealand. hongsoo.wong@otago.ac.nz
authors.forename: Hong Soo
authors.initials: HS
authors.lastname: Wong
authors.forename: John
authors.initials: J
authors.lastname: Hutton
authors.forename: Jane
authors.initials: J
authors.lastname: Zuccollo
authors.forename: John
authors.initials: J
authors.lastname: Tait
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Pringle
mesh_terms: D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008279:Magnetic Resonance Imaging; D010921:Placenta Accreta / Q000175:diagnosis* / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler