title: Prenatal diagnosis of abnormally invasive placenta reduces maternal peripartum hemorrhage and morbidity.
abstract: OBJECTIVE
  Abnormally invasive placenta (AIP) poses diagnostic and therapeutic challenges. We analyzed clinical cases with confirmed placenta increta or percreta.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Multicenter study.
  
  
  METHODS
  Pregnant women with AIP.
  
  
  METHODS
  Chart review.
  
  
  METHODS
  Prenatal detection rates, treatment choices, morbidity, mortality and short-term outcome.
  
  
  RESULTS
  Sixty-six cases were analyzed. All women and all but three fetuses survived; 57/64 women (89%) had previous uterine surgery. In 26 women (39%) the diagnosis was not known before delivery (Group 1), in the remaining 40 (61%) diagnosis had been made between 14 and 37 weeks of gestation (Group 2). Placenta previa was present in 36 women (54%). In Groups 1 and 2, 50% (13/26) and 62% (25/40) of the women required hysterectomy, respectively. In Group 1 (unknown at the time of delivery) 69% (9/13) required (emergency) hysterectomy for severe hemorrhage in the immediate peripartum period compared with only 12% (3/25) in Group 2 (p = 0.0004). Mass transfusions were more frequently required in Group 1 (46%, 12/26 vs. 20%, 8/40; p = 0.025). In 18/40 women (45%) from Group 2 the placenta was intentionally left in situ; secondary hysterectomies and infections were equally frequent (18%) among these differently treated women. Overall, postpartum infections occurred in 11% and 20% of women in Groups 1 and 2, respectively.
  
  
  CONCLUSIONS
  AIP was known before delivery in more than half of the cases. Unknown AIP led to significantly more emergency hysterectomies and mass transfusions during or immediately after delivery. Prenatal diagnosis of AIP reduces morbidity. Future studies should also address the selection criteria for cases appropriate for leaving the placenta in situ.
authors: Department of Obstetrics and Gynecology, CHR Citadelle, Liège, Belgium.
authors: Frédéric
authors: F
authors: Chantraine
authors: Thorsten
authors: T
authors: Braun
authors: Markus
authors: M
authors: Gonser
authors: Wolfgang
authors: W
authors: Henrich
authors: Boris
authors: B
authors: Tutschek
mesh_terms: D000328:Adult; D001530:Belgium / Q000453:epidemiology; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D058725:Peripartum Period; D010921:Placenta Accreta / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D010923:Placenta Previa / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data*; D018570:Risk Assessment; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*; D055815:Young Adult