PACCRETA: clinical situations at high risk of placenta ACCRETA/percreta: impact of diagnostic methods and management on maternal morbidity.
BACKGROUND
No population-based study has assessed the prevalence of placenta accreta, the predictive value of prenatal diagnostic examinations, the maternal morbidity associated with its management, or its psychological effects. Moreover, the technical resources necessary for the safest delivery of women at risk have not been clearly identified.


OBJECTIVE
The primary objectives are to identify individual risk factors, as well as factors associated with types of management and with the healthcare facilities for postpartum hemorrhage. Secondary objectives are to (i) determine the prevalence of placenta accreta among women at risk; (ii) assess the predictive value of ultrasound and MRI for the diagnosis of placenta accreta in this population; (iii) evaluate psychological impact and physical complications; and (iv) report maternal physical complications during the year after delivery.


METHODS
Population-based prospective observational study of pregnant women with a placenta inserted at a uterine scar.


METHODS
A total of 182 centers in eight French regions, with 270 000 deliveries annually.


METHODS
We expect to include 620 women at risk of placenta accreta in two years, of whom approximately 120 (20%) will have placenta accreta.


METHODS
The primary outcome measure is severe maternal hemorrhage; secondary outcome measures are maternal morbidity and deaths, predictive value of ultrasound and MRI, and psychological evaluations at 6 and 12 months.


CONCLUSIONS
This study will be the first prospective population-based study to include women at risk of placenta accreta and to investigate incidence, prenatal detection, type of management, morbidity and maternal psychological consequences.
Department of Obstetrics and Gynecology, Hospital Louis Mourier, University Hospitals Paris Nord Val de Seine (HUPNVS), Assistance Publique-Paris Hospitals (APHP), Paris Diderot University, Paris, France. gkayem@gmail.com
Gilles
G
Kayem
Catherine
C
Deneux-Tharaux
Loic
L
Sentilhes
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D010921:Placenta Accreta / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014599:Uterus / Q000098:blood supply / Q000473:pathology*; D055815:Young Adult