title: [Placenta accreta: screening, management and complications].
abstract: Abnormal placental invasion can result in major obstetric haemorrhage during delivery. The most important risk factors are the following: previous caesarean delivery, placenta praevia maternal age over 35, smoking, previous myomectomy, dilatation and curettage. When placenta accreta is suspected on ultrasound, an RMI can complete the diagnostic. Therefore, patients must be managed, as far as possible, in a reference centre, by a trained medical team. Birth must be planned in order to decrease complications rate. Treatment can consist in radical management (caesarean-hysterectomy) or conservative management (preservation of both uterus and placenta). Conservative management allows patients to keep fertility but can also decrease blood loss during delivery. Side effects of this therapy are secondary haemorrhage, sepsis, long-term follow-up and vaginal loss. There are few studies describing fertility after conservative management, but it seems to be a secure treatment for future pregnancies. Embolization can be a very useful, already demonstrated, help when massive haemorrhage occurs. Management of placenta accreta is multidisciplinary and patients must be informed of all options. Treatment is decided regarding history of the patients, operative findings and peri-partum blood loss.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, Paris, 2 rue Ambroise-Paré, Paris, France. delphine.hequet@gmail.com
authors.forename: D
authors.initials: D
authors.lastname: Héquet
authors.forename: A
authors.initials: A
authors.lastname: Ricbourg
authors.forename: D
authors.initials: D
authors.lastname: Sebbag
authors.forename: M
authors.initials: M
authors.lastname: Rossignol
authors.forename: S
authors.initials: S
authors.lastname: Lubrano
authors.forename: E
authors.initials: E
authors.lastname: Barranger
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D004107:Dilatation and Curettage; D004621:Embolization, Therapeutic; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D007044:Hysterectomy; D008423:Maternal Age; D010921:Placenta Accreta / Q000175:diagnosis* / Q000628:therapy*; D010923:Placenta Previa; D006473:Postpartum Hemorrhage; D011247:Pregnancy; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D063186:Uterine Myomectomy / Q000009:adverse effects