[Clinical analysis of 47 cases of placenta accreta in the second and third trimesters].
OBJECTIVE
To explore the clinical characters, diagnosis and treatment methods of placenta accreta.


METHODS
A retrospective analysis was made of 47 cases of placenta accreta admitted during May 1997 to May 2007 into Peking Union Medical College Hospital. They included 17 cases in the second trimester and 30 cases in the third.


RESULTS
Among all the patients, the incidence of placenta accreta was 0.262% (47/17 918). Most of these cases (81%, 38/47) experienced a uterine procedure. 30% (14/47) of the cases were found with placenta previa and 11% (5/47) with myoma in the current pregnancy. 11% (5/47) of all the cases suffered postpartum hemorrhage. In the 17 cases in the second trimester, 12 were diagnosed by ultrasonography and 5 by clinical evidence. While in the 30 cases in the third trimester, 8 were diagnosed by biopsy, 2 by ultrasonography, and 20 by clinical evidence. 45 cases were cured by conservative treatment, which included dilatation and curettage, uterine artery embolization (UAE) with or without methotrexate (MTX), tamping B-lynch suture, singly with MTX, and mifepristone. Only 2 cases received cesarean hysterectomy.


CONCLUSIONS
The incidence of placenta accreta seems on the rise. The incidence in the second trimester is higher than that in the third. In the second trimester, most cases can be diagnosed by ultrasonography after labor, and presently UAE is the best conservative management. While in the third trimester clinical evidence is the most frequent diagnostic approach. A majority of the cases could be cured by conservative therapies, which help them avoid a hysterectomy.
Zhang
Chao
C
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Liu
Xin-yan
XY
Fan
Guang-sheng
GS
Yang
Jian-qiu
JQ
Liu
Jun-tao
JT
Bian
Xu-ming
XM
D000328:Adult; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008727:Methotrexate / Q000627:therapeutic use; D010921:Placenta Accreta / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D010923:Placenta Previa; D006473:Postpartum Hemorrhage; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D055357:Uterine Artery Embolization; D014599:Uterus / Q000098:blood supply; D055815:Young Adult
D008727:Methotrexate