title: Antenatal diagnosis of placenta accreta leads to reduced blood loss.
abstract: OBJECTIVE
  Placenta accreta is one of the most devastating pregnancy complications. We sought to compare outcomes between women with placenta accreta when diagnosed antenatally or intrapartum, and to define predictors of the antenatal diagnosis.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Twenty-four women with placenta accreta diagnosed antenatally and 20 women discovered intrapartum.
  
  
  METHODS
  Chart review of historical and delivery-associated variables. Rates were compared between the groups.
  
  
  METHODS
  Placenta accreta diagnosed antenatally or intrapartum.
  
  
  RESULTS
  Women with antenatal diagnosis had a lower estimated blood loss of a median of 4500ml (range 100-15000ml) compared with 7800ml (range 2500-17000ml, p=0.012) and required fewer units of packed red blood cells transfused (median 7; range 0-27 compared with 13.5; range 4-31, p=0.026). Nineteen (79%) women diagnosed antenatally had balloon catheter occlusion carried out during the cesarean section. Five (21%) had the entire placenta left in situ. There was no difference in the rate of surgical complications or duration of hospitalization. The clinical diagnosis among women with antenatal diagnosis was more often placenta percreta (p=0.013). The risk factor profile of women with antenatal diagnosis of placenta accreta included higher gravidity (p=0.014) and parity (p<0.0001), history of cesarean section (p=0.004), and placenta previa in the current pregnancy (p<0.001).
  
  
  CONCLUSIONS
  Antenatal diagnosis of placenta accreta may reduce peripartum blood loss and the need for blood transfusion. Women with antenatal diagnosis more often have placenta previa and history of previous cesarean section, and the clinical diagnosis is more often placenta percreta.
authors.affiliation: Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland. minna.tikkanen@hus.fi
authors.forename: Minna
authors.initials: M
authors.lastname: Tikkanen
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
authors.forename: Mikko
authors.initials: M
authors.lastname: Loukovaara
authors.forename: Vedran
authors.initials: V
authors.lastname: Stefanovic
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods; D016022:Case-Control Studies; D002585:Cesarean Section / Q000379:methods; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010921:Placenta Accreta / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000517:prevention & control* / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal