title: Maternal outcome after conservative treatment of placenta accreta.
abstract: OBJECTIVE
  To estimate maternal outcome after conservative management of placenta accreta.
  
  
  METHODS
  This retrospective multicenter study sought to include all women treated conservatively for placenta accreta in tertiary university hospital centers in France from 1993 to 2007. Conservative management was defined by the obstetrician's decision to leave the placenta in situ, partially or totally, with no attempt to remove it forcibly. The primary outcome was success of conservative treatment, defined by uterine preservation. The secondary outcome was a composite measure of severe maternal morbidity including sepsis, septic shock, peritonitis, uterine necrosis, fistula, injury to adjacent organs, acute pulmonary edema, acute renal failure, deep vein thrombophlebitis or pulmonary embolism, or death.
  
  
  RESULTS
  Of the 40 university hospitals that agreed to participate in this study, 25 institutions had used conservative treatment at least once (range 1-46) and had treated a total of 167 women. Conservative treatment was successful for 131 of the women (78.4%, 95% confidence interval [CI] 71.4-84.4%); of the remaining 36 women, 18 had primary hysterectomy and 18 had delayed hysterectomy (10.8% each, 95% CI 6.5-16.5%). Severe maternal morbidity occurred in 10 cases (6.0%, 95% CI 2.9-10.7%). One woman died of myelosuppression and nephrotoxicity related to intraumbilical methotrexate administration. Spontaneous placental resorption occurred in 87 of 116 cases (75.0%, 95% CI 66.1-82.6%), with a median delay from delivery of 13.5 weeks (range 4-60 weeks).
  
  
  CONCLUSIONS
  Conservative treatment for placenta accreta can help women avoid hysterectomy and involves a low rate of severe maternal morbidity in centers with adequate equipment and resources.
authors.affiliation: From the Departments of Obstetrics and Gynecology, Angers University Hospital, Angers; Rouen University Hospital, Charles Nicolle, Rouen; Rennes University Hospital, Rennes; Maternité Port-Royal Hospital, Cochin APHP, University René Descartes, Paris; Centre Hospitalier Intercommunal de Créteil, University of Paris XII, Henri Mondor, Créteil; Conception Hospital, University of Mediterranee, Marseille; North Hospital, University of Mediterranee, Marseille; Antoine Béclère Hospital, University Paris Sud, Paris; Kremlin-Bicètre Hospital, University Paris Sud, Paris; Tours University Hospital, Tours; Nantes University Hospital, Nantes; CHU La Milétrie Hospital, University of Poitiers, Poitiers; Hôpital Necker-Enfants Malades, University René Descartes, Paris; Caen University Hospital, Caen; and Hôpital Bichat Claude-Bernard, APHP, University Paris-VII, Paris, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Sentilhes
authors.forename: Clémence
authors.initials: C
authors.lastname: Ambroselli
authors.forename: Gilles
authors.initials: G
authors.lastname: Kayem
authors.forename: Magali
authors.initials: M
authors.lastname: Provansal
authors.forename: Hervé
authors.initials: H
authors.lastname: Fernandez
authors.forename: Franck
authors.initials: F
authors.lastname: Perrotin
authors.forename: Norbert
authors.initials: N
authors.lastname: Winer
authors.forename: Fabrice
authors.initials: F
authors.lastname: Pierre
authors.forename: Alexandra
authors.initials: A
authors.lastname: Benachi
authors.forename: Michel
authors.initials: M
authors.lastname: Dreyfus
authors.forename: Estelle
authors.initials: E
authors.lastname: Bauville
authors.forename: Dominique
authors.initials: D
authors.lastname: Mahieu-Caputo
authors.forename: Loïc
authors.initials: L
authors.lastname: Marpeau
authors.forename: Philippe
authors.initials: P
authors.lastname: Descamps
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D010120:Oxytocics / Q000627:therapeutic use; D010921:Placenta Accreta / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010120:Oxytocics