[Maternal morbidity and mortality associated with conservative management for placenta morbidly adherent (accreta) diagnosed during pregnancy. Report of 15 cases].
BACKGROUND
High risk of morbidly adherent placenta increased during past years. Their management is controversial. Cesarean hysterectomy, considered the gold standard treatment by American Society, is associated with high risk of maternal morbimortality. Conservative management has been sought to reduce maternal morbidity associated with caesarean hysterectomy while maintaining fertility. It consists of leaving the placenta in place but long-term monitoring. Our main objective was to determine advantage/disadvantage of conservative management on patient with an antenatal diagnosis of placenta accreta, increta or percreta.


METHODS
This retrospective study included all patients with an antenatal diagnosis of placenta accreta, increta or percreta between 2007 and 2014. Conservative treatment was systematically attempted according to our protocol. The primary outcome was defined as uterine conservation and the secondary outcome as maternal morbimortality defined as any medical or surgical condition occurring after childbirth.


RESULTS
Fifteen patients (0.07 % of all living childbirths) were included. Conservative management was successful in 80 % of patients. There was no case of maternal death. Severe post-partum hemorrhage occurred in 4 patients (33.3 %) requiring uterine arteries embolization in one patient and hysterectomy in the 3 others. They underwent immediate blood transfusion of 13.5±4.5 average of red blood cell units. No severe septic condition occurred but 4 patients suffered from endometritis, 2.6±0.5 months after birth requiring intravenous antibiotics treatment in conventional hospitalization. Mean duration for spontaneous abortion of the placenta was 23.0±7.2 weeks. Three spontaneous pregnancies occurred in 2 patients after 19±16.9 months.


CONCLUSIONS
Conservative management seems encouraging but is associated with a non-insignificant risk of secondary complication requiring long-term monitoring in conciliant patients.
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France. Electronic address: fanny.demarcillac@chru-strasbourg.fr.
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Daney de Marcillac
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France.
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Lecointre
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France.
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Guillaume
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France.
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Sananes
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France.
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Fritz
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France.
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Viville
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France.
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Boudier
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France.
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Nisand
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France.
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Gaudineau
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France.
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Langer
Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue de Molière, 67098 Strasbourg cedex 2, France.
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Akladios
D000328:Adult; D001803:Blood Transfusion / Q000379:methods; D002585:Cesarean Section / Q000379:methods* / Q000401:mortality; D000072700:Conservative Treatment / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care; D010921:Placenta Accreta / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy; D011247:Pregnancy; D012189:Retrospective Studies; D055357:Uterine Artery Embolization / Q000379:methods
Accreta/increta/percreta; Conservative management; Maternal morbimortality; Morbidly adherent placenta; Morbimortalité maternelle; Placenta anormalement adhérent; Traitement conservateur