title: Conservative Management of Placenta Accreta/Increta after Vaginal Birth.
abstract: Aim:Aim of the study was to show that conservative management with preservation of the uterus and of fertility is possible in patients with placenta accreta/increta after vaginal delivery.Method:A retrospective analysis of patients with placental attachment disorders after vaginal delivery was done in a perinatal centre between November 2009 and April 2011. The patient collective was identified using the ICD-10 codes for placenta accreta/increta/percreta, and patient records were analysed for risk factors, maternal morbidity, preservation of the uterus and of fertility, and neonatal outcome.Results:Three cases of placenta increta were identified in the last 1.5 years out of a total of 1457 vaginal deliveries, and all 3 cases were treated conservatively. Mean maternal age was 35.3 years; gestational age ranged from 39 to 41 weeks, and mean duration between delivery of the child and delivery of the placenta was 44.67 days (range: 14-100 days). Two patients developed symptoms of endomyometritis, including fever, leukocytosis and increased CRP levels. All 3 women were successfully managed with preservation of the uterus.Conclusion:In selected cases with placenta accreta/increta after vaginal delivery, it is possible to avoid surgical procedures, particularly hysterectomy procedures, and successfully manage these patients conservatively with preservation of the uterus.
authors.affiliation: Obstetrics and Gynaecology Department, Johann Wolfgang Goethe University Frankfurt, Frankfurt/Main.
authors.forename: S
authors.initials: S
authors.lastname: Peiffer
authors.affiliation: St. Marienkrankenhaus, Obstetrics and Gynaecology Department, Frankfurt/Main.
authors.forename: J
authors.initials: J
authors.lastname: Reinhard
authors.affiliation: Obstetrics and Gynaecology Department, Johann Wolfgang Goethe University Frankfurt, Frankfurt/Main.
authors.forename: A
authors.initials: A
authors.lastname: Reitter
authors.affiliation: Obstetrics and Gynaecology Department, Johann Wolfgang Goethe University Frankfurt, Frankfurt/Main.
authors.forename: F
authors.initials: F
authors.lastname: Louwen
keywords: conservative management; outcome; placenta accreta/increta