Surgical management of placenta accreta: a cohort series and suggested approach.
OBJECTIVE
The purpose of this study was to describe the use of a staged procedure that involved femoral artery catheterization, classic cesarean section delivery, and uterine and placental embolization before hysterectomy for placenta accreta.


METHODS
We conducted a cohort study of retrospective and prospective data from cases of histologically identified placenta accreta at a tertiary teaching hospital with access to interventional radiology.


RESULTS
Twenty-six cases of placenta accreta were identified histologically (7 accretas, 5 incretas, and 14 percretas); 8 cases were successful staged embolization procedures. These cases had significant reductions in blood loss (553 vs 4517 mL; P = .0001), need for transfusion (2 vs 16; P = .001), and units of blood transfused (0.5 vs 7.9; P = .0013). The total operation time was no different between the 2 groups, but there was a longer length of anesthesia (2.7 vs 6.6 hours; P = .0001). There were nonsignificant reductions in admission to the intensive care unit and length of hospital stay.


CONCLUSIONS
We found that the successful use of a staged embolization hysterectomy procedure for placenta accreta is associated with decreased maternal morbidity.
Angstmann
Tobias
T
Royal North Shore Hospital, St. Leonards, NSW, Australia.
Gard
Gregory
G
Harrington
Tim
T
Ward
Elizabeth
E
Thomson
Amanda
A
Giles
Warwick
W
D000293:Adolescent; D000328:Adult; D002404:Catheterization; D036861:Delivery, Obstetric / Q000379:methods*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007902:Length of Stay; D008875:Middle Aged; D010921:Placenta Accreta / Q000601:surgery*; D011247:Pregnancy; D011280:Pregnanolone; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018616:Ultrasonography, Doppler, Duplex; D055815:Young Adult
D011280:Pregnanolone