title: Prenatal sonographic diagnosis of placenta accreta--impact on maternal and neonatal outcomes.
abstract: OBJECTIVE
  To compare maternal and neonatal outcomes of prenatally diagnosed versus undiagnosed cases of placenta accreta.
  
  
  METHODS
  This retrospective study included all pathology-proven placentas accreta/increta/percreta from a single tertiary center from January 1, 2005 to December 31, 2012. Outcomes were compared between prenatally diagnosed and undiagnosed cases.
  
  
  RESULTS
  Thirty-six cases of abnormal implantations were identified, of which 19 (53%) were prenatally diagnosed by ultrasound. Prenatal detection was more likely with a percreta (7/19 versus 2/17, p = .07), parity (18/19 versus 9/17, p = .01), prior cesarean (17/19 versus 4/17, p = .0001), shorter cesarean-conception interval (22.8 ± 21.4 versus 108 ± 7.6 months, p = .01), and spontaneous conception (19/19 versus 12/17, p = .03). Cases diagnosed prenatally more frequently received steroids for fetal maturity (13/20 versus 3/19, p = .003), delivered by cesarean (19/19 versus 11/17, p = .01) under general anesthesia (14/19 versus 4/17, p = .002) with a cell saver (5/19 versus 0/17, p = .06). There were no statistically significant differences by group in maternal blood loss, transfusion, intensive care admission or length of stay, operative injury, or severe composite morbidity (reoperation, coagulopathy, thromboembolism, wound infection, multiorgan failure, transfusion reaction, fistula, or chest compressions). There were no statistically significant differences in 5-minute Apgar <7, neonatal intensive care unit admission or length of stay, or severe composite morbidity.
  
  
  CONCLUSIONS
  Prenatally undiagnosed accretas are less complex than prenatally diagnosed cases, but associated with statistically similar outcomes, suggesting benefit to prenatal recognition.
authors: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, ME.
authors: Tania
authors: T
authors: Hall
authors: Joseph R
authors: JR
authors: Wax
authors: F Lee
authors: FL
authors: Lucas
authors: Angelina
authors: A
authors: Cartin
authors: Michael
authors: M
authors: Jones
authors: Michael G
authors: MG
authors: Pinette
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010921:Placenta Accreta / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: adherent placenta; maternal morbidity; placenta accreta; prenatal ultrasound