Conservative management of placenta previa complicated by abnormal placentation.
OBJECTIVE
Abnormal implantation of placenta previa is life-threatening condition. The purpose of this study was to evaluate the impact of the conservative management of pregnancies with such complication on maternal morbidity rate and the chance for uterine preservation (fertility).


METHODS
Eleven patients with abnormal implantation of placenta previa were analyzed prospectively. This complication was diagnosed antenatally by two-dimensional ultrasound and color flow Doppler. The following outcomes were analyzed: need for blood transfusion, admission and duration of stay in intensive care unit, infections, coagulopathies, time between cesarean section and delivery of placenta, hysterectomy and preservation of uterus.


RESULTS
Among the 20 085 women who had a singleton gestation, 11 (0.054%) were identified with placenta previa with abnormal placentation. In five patients (group A), hysterectomy was performed because of hemorrhage or placenta ablation. In six patients (group B), conservative management succeeded and placenta were preserved. In group A, placenta were delivered earlier (2 d-8 weeks) in comparison with group B (6-15 weeks). Estimated blood loss during the delayed delivery of placenta was higher in the group with hysterectomy (respectively, 450-1600 and 300-500 ml).


CONCLUSIONS
Conservative management of placenta previa with abnormal implantation decreases the risk of severe hemorrhage at the time of delivery and can preserve fertility.
Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poznań, Poland. gbrebor@wp.pl
Grzegorz H
GH
Bręborowicz
Wiesław
W
Markwitz
Michał
M
Gaca
Agnieszka
A
Koziołek
Mariola
M
Ropacka-Lesiak
Anna
A
Dera
Mariusz
M
Brych
Marta
M
Szymankiewicz-Bręborowicz
Grzegorz
G
Kruszyński
Karolina
K
Gruca-Stryjak
Mateusz
M
Madejczyk
Agata
A
Szpera-Goździewicz
Mariola
M
Krzyścin
D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000379:methods; D005260:Female; D059247:Fertility Preservation / Q000379:methods; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data; D059351:Organ Sparing Treatments / Q000379:methods* / Q000706:statistics & numerical data; D010920:Placenta / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D010923:Placenta Previa / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D010929:Placentation / Q000502:physiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery; D011247:Pregnancy; D016216:Ultrasonography, Prenatal