The morbidly adherent placenta: an overview of management options.
Abstract Morbidly adherent placenta is often associated with severe maternal morbidity. An increased incidence over the recent years may be secondary to the increased cesarean section rates. Identification of patients with risk factors antenatally is essential for the early diagnosis and management. Diagnosis can be achieved by ultrasound or MRI in the majority of cases. Management aims to ensure a safe delivery of the fetus, alongside measures of prevention or effective management of postpartum hemorrhage. When a hysterectomy is performed, a multidisciplinary team with surgical expertise and facilities for transfusion and further interventions including arterial ligation and interventional radiology should be available. The options for conservative treatments offer the potential to preserve fertility but further research with prospective evaluation of the different approaches is necessary.
Doumouchtsis
Stergios K
SK
Department of Obstetrics and Gynaecology, St. George's University of London, UK. sdoum@yahoo.com
Arulkumaran
Sabaratnam
S
D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002404:Catheterization; D002585:Cesarean Section; D004621:Embolization, Therapeutic; D005260:Female; D005298:Fertility; D005493:Folic Acid Antagonists / Q000627:therapeutic use; D006801:Humans; D007044:Hysterectomy; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000627:therapeutic use; D009215:Myometrium / Q000473:pathology; D010920:Placenta / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D010921:Placenta Accreta / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D010923:Placenta Previa / Q000628:therapy; D011182:Postoperative Care; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D011295:Prenatal Care; D011300:Preoperative Care; D012307:Risk Factors; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000601:surgery
D005493:Folic Acid Antagonists; D008727:Methotrexate