title: [Management of placenta previa and accreta].
abstract: OBJECTIVE
  Produce recommendations for the management of placenta previa and placenta accrete.
  
  
  METHODS
  A literature search was conducted using Medline and the Cochrane Library over a period from 1950 to 31/12/2013. Recommendations of the latest scientific societies have also been consulted.
  
  
  RESULTS
  In cases of placenta previa, if bleeding episode before 34weeks gestation occurs, a short hospitalization and tocolysis may help stop bleeding (grade C). Vaginal delivery is preferable when the distance between the internal cervical os and the placental edge is greater than 20mm. When this distance is less than 20mm, vaginal delivery is possible (professional consensus). Caesarean section is recommended in cases of placenta overlapping the internal os (professional consensus). Antenatal screening placenta accreta could improve care (EL3). Upon discovery of a placenta accreta during childbirth, it is better to avoid a forced removal of the placenta (grade C). Conservative treatment or cesarean hysterectomy are possible (grade C). The management of placental abnormalities should be planned and managed with a multidisciplinary team (professional consensus). The use of blood-saving techniques such as "cell saver" is possible in situations where early intraoperative bleeding would be>1500mL (grade C). There are no studies that have sufficient methodological value to recommend an anesthetic technique [general anaesthesia (GA) or neuraxial anaesthesia] over another in the context of placental abnormalities (grade B). When a major bleeding risk is identified, GA can be chosen in order to avoid emergency conversions in difficult conditions (professional consensus).
  
  
  CONCLUSIONS
  Placental insertion abnormalities require anesthetic and obstetric coordination. Delivery must be planned in a suitable structure.
authors.affiliation: Maternité, département hospitalo-universitaire (DHU) « Risques et grossesse », hôpital Louis-Mourier, hôpitaux universitaires Paris Nord Val-de-Seine (HUPNVS), AP-HP, 178, rue des Renouillers, 92700 Colombes, France; Université Paris-Diderot, 5, rue Thomas-Mann, 75205 Paris cedex 13, France. Electronic address: gkayem@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Kayem
authors.affiliation: Service d'anesthésie, CHU Louis-Mourier, AP-HP / Université Paris-7, 178, rue des Renouilliers, 92700 Colombes, France; Université Paris-Diderot, Sorbonne Paris Cité, EA recherche clinique coordonnée ville-hôpital, méthodologies et société (REMES), 75010 Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Keita
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000592:standards*; D010921:Placenta Accreta / Q000601:surgery / Q000628:therapy*; D010923:Placenta Previa / Q000601:surgery / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000601:surgery / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy
keywords: Anesthetic technique; Cell saver; Conservative treatment; Hysterectomy; Hystérectomie; Hémorragie du post-partum; Hémorragie massive; Massive hemorrhage; Multidisciplinary; Placenta accreta; Placenta accrete; Placenta praevia; Placenta previa; Pluridisciplinarité; Postpartum hemorrhage; Technique anesthésique; Traitement conservateur; « Cell saver »